脑钠肽联合中心静脉压评价血液滤过患者血容量与心脏功能的价值  

The value of BNP combined with central venous pressure in evaluating volume and cardiac function in patients with hemofiltration

作　　者：万美燕[1] 韩昆[2] 崔永军[1] 

机构地区：[1]青岛市市立医院肾内科,山东青岛266011 [2]青岛大学附属医院神经外科,山东青岛266001

出　　处：《中华全科医学》2016年第2期243-244,312,共3页Chinese Journal of General Practice

基　　金：山东省青岛市2011年度医药科研指导计划(2011-WSZD-022)

摘　　要：目的 准确评价血液滤过患者的血容量与心脏功能,将有效减少或避免血液滤过相关性低血压的发生,联合脑钠肽与中心静脉压的测定应用于血液滤过患者,以期为此类患者提供一种有效的评价血容量及心功能的手段。方法 选择在青岛市市立医院肾内科和ICU因心功能不全行血液滤过治疗的CKD 5期患者36例,当血液滤过后患者心功能由Ⅳ级转为Ⅲ级或Ⅱ级,停止血液滤过,分别检测患者血液滤过前、后血清BNP水平;同时应用心脏超声心动图测定患者血液滤过前、后的左心房内径、左心室内径、室间隔厚度、左心室后壁厚度、左心室射血分数等。所得数据均以SPSS 19.0统计软件进行统计分析,描述性变量用x^-±s或中位数表示;差别的显著性检验采用t检验;2组间均数比较采用独立样本方差分析。结果 ①患者血滤前、后血清BNP水平差异有统计学意义（t=6.494,P〈0.01）,但是尿毒症患者血滤后BNP水平仍高于正常。②患者血液滤过前、后室间隔厚度、左心室后壁厚度、左心室射血分数等,差异有统计学意义（t=2.131-2.591,P=0.037-0.012）,血滤后患者的室间隔厚度与左心室后壁厚度仍高于正常。③患者血滤前、后中心静脉压差异有统计学意义（t=11.589,P〈0.01）。结论BNP联合中心静脉压能准确评估尿毒症患者的容量负荷和左心功能;尿毒症患者多数存在左室肥厚及BNP水平升高。Objective To explore the value of brain natriuretic peptide （BNP） combined with central venous pressure （CVP） in evaluating volume and cardiac structure and function in uremic patients with hemofihration（HF）. Methods Thirty-six uremic patients with hemofihration were enrolled. According to hemofihration, the patients were divided into 2 groups ： B （Before） group and A （After） group. When the cardiac function of uremic patients with hemofihration was from level Ⅳ to level m or level Ⅱ , the volume status of the patients was appropriate. Some laboratoly parameters and BNP were detected in all patients. All patients were measured by echocardiography for cardiac structure and function. The CVP of the two groups were measured. The clinical data, laboratory parameters and cardiac ultrasound parameters were compared between B and A group. All data were analyzed with statistical software SPSS 17.0. Results Although the values of BNP in uremic patients were significantly decreased after hemofiltration（ t = 6.494 ,P 〈 0.01 ） ,they were still higher than normal. The difference of interventrieular septum thickness,left ventricular posterior wall thickness and left ventricular ejection fraction between B and A group were significant（t =2. 131 -2. 591 ,P =0. 037 -0. 012）. The difference of CVP between B group and A group were significant（ t = 11. 589,P 〈 0.01 ）. Conclusion BNP combined with CVP can accurately evaluate the volume status and cardiac structure and function in uremic patients. The values of BNP in uremic patients were high, and it was related to left ventricular hypertrophy.

关 键 词：脑钠肽 血液滤过 中心静脉压 心脏功能 

分 类 号：R692[医药卫生—泌尿科学] R459.5[医药卫生—外科学]