肺动脉压与脑钠肽对脓毒性休克患者预后的价值  

Value explore and correlation analysis on pulmonary artery pressure and brain natriuretic peptide predicting prognosis in septic shock patients

作　　者：王平[1] 张丽涓[1] 周贵[1] 陈燕春[1] 

机构地区：[1]成都市第五人民医院重症医学科,四川成都611130

出　　处：《中华医学杂志》2015年第27期2194-2197,共4页National Medical Journal of China

基　　金：四川省卫生厅科研课题（120527）

摘　　要：目的探讨在脓毒性休克患者中，肺动脉压力（PAP）、脑利尿钠肽（BNP）的增高程度以及患者预后的关系。方法2013年5月至2014年10月成都市第五人民医院重症医学科脓毒性休克患者48例；其中存活组27例，病死组21例。置入Swan-Ganz导管，连续3d监测肺动脉压力、肺血管阻力、肺毛细血管楔压、心输出量以及脑利尿钠肽；分析存活患者和病死患者PAP、肺血管阻力（PVR）、肺毛细血管楔压（PCWP）、心输出量（CO）、BNP的差异；采用线性相关分析BNP与PAP、CO的相关性。结果入院时两组患者血流动力学参数差异无统计学意义（P〉0．05），治疗第48、72小时，死亡患者肺动脉压力高于存活患者[（20．8±5．8）mmHg比（34．2±7．4）mmHg，P〈0．05]。治疗第24、48、72小时死亡患者和存活患者PVR、PCWP、CO差异无统计学意义（P〉0．05）。死亡患者在入科48、72h血浆BNP高于存活患者[（286．5±75．5）pg／ml比（675．4±51．3）pg,／ml，P〈0．05]。线性相关分析显示，BNP与PAP、CO均无明显相关性。结论在脓毒性休克患者中肺动脉压力及血浆BNP增高提示患者预后不良，肺动脉高压需要被关注。与心衰的患者不同，在脓毒性休克患者中，血浆BNP增高并不说明患者心功能不良，不能用于指导心功能治疗。Objective To evaluate and explore the relationship among the pulmonary artery pressure, Brain natriuretic peptide and the prognosis in the patients with septic shock. Methods From May 2013 to Oct. 2014,48 patients were treated with Swan-Ganz catheter to monitor the pulmonary artery pressure, the pulmonary vascular resistance, the pulmonary capillary wedge pressure and cardiac output. Testing brain natriuretie peptide, Analysising the differences between survival patients （27 cases ） and dead patients （21 cases） in the PAP, PVR, PCWP, CO and BNP,Analysising the correlation between BNP and PAP, PVR, PCWP, CO by Linear correlation analysis. Results It is no difference in hemodynamie parameters between dead patients and survival patients when they come in the hospital （P 〉 0.05 ） ; it is significant difference in hemodynamie parameters between dead patients and survival patients when they came in the hospital after 48 hours or 72 hours [ （20. 8 ± 5.8 ） mmHg vs （34. 2 ± 7. 4） mmHg, P 〈0. 05] ,it is no difference in PVR,PCWR and CO at 24 hours ,48 hours or 72 hours. Then it is significant difference in BNP between dead patients and survival patients that they had been entered the hospital after 48 hours or 72 hours[ （286.5 ±75.5） pg/ml vs （675.4 ±51.3） pg/ml,P 〈0.05], it has no obvious correlation among the BNP, PAP and CO. Conclusions It prompts a poor prognosis if the patients with septic shock had increased the pulmonary artery pressure and the BNP. Therefore it is need focus on pulmonary hypertension, it is different if BNP of plasma in heart failure patients increased, it does not mean heart function failuring, so it can not be used to give a guide to therapy on heart function.

关 键 词：脓毒性休克 肺动脉高压 脑钠肽 

分 类 号：R459.7[医药卫生—急诊医学]