不同类型休克患者的肺动脉收缩压对预后的诊断价值  

Diagnostic value of pulmonary arterial systolic blood pressure for prognosis in patients with different types of shock

作　　者：蔡雪敏 郑伟浩[1] 张爽[1] 李超梁[1] CAI Xue-min;ZHENG Wei-hao;ZHANG Shuang;LI Chao-liang(Department of Intensive Care Unit,Jiangmen Central Hospital,Guangdong Province,Jiangmen529000,China)

机构地区：[1]广东省江门市中心医院重症医学科,广东江门529000

出　　处：《中国当代医药》2021年第3期58-61,共4页China Modern Medicine

摘　　要：目的观察不同类型休克患者的肺动脉收缩压(PASP)评估PASP对休克患者死亡的预测价值。方法回顾性分析2017年1月~2018年12月江门市中心医院收治的155例休克患者的临床资料。根据休克类型分为感染性休克组(93例)、心源性休克组(21例)、低血容量性休克组(41例)。检测患者的血乳酸(LAC)、N末端B型利钠肽原(NT-proBNP)、白细胞计数(WBC)的水平以及PASP的数值。结果感染性休克组PASP、NT-proBNP、死亡率高于低血容量性休克组,差异有统计学意义(P<0.05);感染性休克组NT-proBNP低于心源性休克组,差异有统计学意义(P<0.05);心源性休克组NT-proBNP、死亡率高于低血容量性休克组,差异有统计学意义(P<0.05);PASP与NT-proBNP呈正相关(r=0.289,P<0.05),PASP与LAC无相关性(P>0.05);受试者工作特征(ROC)曲线分析结果显示,休克患者PASP死亡预测价值优于LAC及NT-proBNP(P<0.05)。结论PASP是休克患者有效的死亡预测指标,可以更好地识别休克的发生与发展,提高重症医学科患者的抢救成功率,值得在临床中推广及运用。Objective To observe pulmonary artery systolic pressure(PASP)of patients with different types of shock and evaluate the predictive value of PASP for death in shock patients.Methods The clinical data of 155 patients with shock who were admitted to Jiangmen Central Hospital from January 2017 to December 2018 were retrospectively analyzed.According to the type of shock,they were divided into septic shock group(93 cases),cardiogenic shock group(21 cases)and hypovolemic shock group(41 cases).The levels of blood lactate(LAC),N-terminal pro-B-type natriuretic peptide(NT-proBNP),white blood cell count(WBC)as well as the values of PASP in the patients were detected.Results PASP,NT-proBNP and mortality of the septic shock group were higher than those in hypovolemic shock group,the differences were statistically significant(P<0.05).NT-proBNP was lower than that in cardiogenic shock group,the difference was statistically significant(P<0.05).NT-proBNP and mortality in cardiogenic shock group were higher than those in hypovolemic shock group,the differences were statistically significant(P<0.05).PASP was positively correlated with NT-proBNP(r=0.289,P<0.05),while PASP was not correlated with LAC(P>0.05).Receiver operating characteristic(ROC)curve analysis results showed that PASP had better predictive value than NT-proBNP and LAC(P<0.05).Conclusion PASP is an effective death prediction index for patients with shock,which can better identify the occurrence and development of shock and improve the success rate of rescue of patients in critical medicine department.It is worthy of promotion and application in clinical practice.

关 键 词：感染性休克 心源性休克 低血容量性休克 肺动脉收缩压 血乳酸 N末端B型利钠肽原 

分 类 号：R441.9[医药卫生—诊断学]