血浆脑钠肽和降钙素原水平在指导重症肺炎患者机械通气脱机中的应用价值  

Application value of plasma brain natriuretic peptide and procalcitonin level in guiding severe pneumonia patients with offline mechanical ventilation

作　　者：钟映玉[1,2] 陈宇冲 罗文滔 黄寿新 肖百芳[1,2] 邹新辉[1] ZHONG Yingyu;CHEN Yuchong;LUO Wentao;HUANG Shouxin;XIAO Baifang;ZOU Xinhui(Department of Emergency Intensive Care, Meizhou People's Hospital, Guangdong, Meizhou 514031, China;Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population)

机构地区：[1]梅州市人民医院急诊重症监护科,广东梅州514031 [2]广东省客家人群精准医学与临床转化研究重点实验室

出　　处：《包头医学院学报》2020年第6期6-8,共3页Journal of Baotou Medical College

基　　金：2018年度梅州市社会发展科技计划项目(190102122051674)。

摘　　要：目的:探讨分析血浆脑钠肽和降钙素原水平在指导重症肺炎患者机械通气脱机中的应用价值。方法:选取2018年12月至2020年4月期间入住ICU科的55例重症肺炎患者,达到撤机标准后撤机,比较成功组与失败组患者机械通气24 h后血浆脑钠肽(BNP)、降钙素原(PCT)及生命体征指标,Logistic回归分析患者机械通气脱机成败的影响因素,分析BNP、PCT预测患者机械通气脱机成败的ROC曲线。结果:机械通气24 h后成功脱机组患者BNP、PCT水平分别为(978.56±1664.27)ng/mL、(0.17±1.26)pg/mL,低于脱机失败的患者的(6504.00±75562.28)ng/mL、(4.78±6.51)pg/mL(P<0.05);成功脱机组氧合指数为(315.84±121.95)mmHg,高于脱机失败组的(245.19±95.54)mmHg(P<0.05);两组患者心率、平均动脉压差异无统计学意义(P>0.05);Logistic回归分析结果显示,BNP、PCT指标水平进入方程,且均为影响机械通气脱机的危险因素,BNP水平预测患者脱机成败的ROC曲线下的面积(AUC)为0.674,在0.5~0.7范围内,预测效果一般,灵敏度为0.738,特异度为0.511,PCT水平预测患者脱机成败的ROC曲线下的面积(AUC)为0.912,在0.85~0.95范围内,预测效果很好,灵敏度为0.779,特异度为0.908。结论:机械通气24 h后重症肺炎的BNP、PCT水平均是影响脱机成功率的独立危险因素,可有效指导其脱机,提高脱机的成功率,值得在临床上推广。Objective:To explore the application value of plasma brain natriuretic peptide and procalcitonin in guiding patients with severe pneumonia to take mechanical ventilation offline.Methods:A total of 55 patients with severe pneumonia admitted to ICU department from December 2018 to April 2020 were selected and discharged after meeting the withdrawal standard.Plasma brain natriuretic peptide(BNP),procalcitonin(PCT)and vital signs were compared 24 h after mechanical ventilation between the successful group and the failed group.Logistic regression analysis was conducted to analyze the factors influencing the success or failure of mechanical ventilation weaning of patients,and ROC curve of BNP and PCT predicting the success or failure of mechanical ventilation weaning of patients was analyzed.Results:The BNP and PCT level of the patients who were successfully deactivated after 24 h mechanical ventilation was(978.56±1664.27)ng/mL(0.17±1.26)pg/mL,which was lower than that of the patients who failed to weaning(6504.00±75562.28)ng/mL(4.78±6.51)pg/mL(P<0.05).The oxygenation index of the successful deoxygenation group was(315.84±121.95)mmHg,which was higher than that of the failed weaning group(245.19±95.54)mmHg(P<0.05).There was no significant difference in mean heart rate arterial pressure between the two groups(P>0.05).Logistic regression analysis results showed that BNP and PCT indexes were included in the equation,and both of them were risk factors affecting mechanical ventilation weaning.The area under the ROC curve(AUC)of BNP level to predict the success or failure of patients'offline was 0.674.Within the range of 0.5~0.7,the prediction effect was general,the sensitivity was 0.738,and the specificity was 0.511.The area under ROC curve(AUC)of PCT level to predict the success or failure of patients'offline was 0.912,with a good prediction effect in the range of 0.85~0.95,with a sensitivity of 0.779 and a specificity of 0.908.Conclusion:BNP and PCT levels of severe pneumonia after 24 h of mechanical ventilation are

关 键 词：血浆脑钠肽 降钙素原 重症肺炎 机械通气 撤机 

分 类 号：R54[医药卫生—心血管疾病]