感染性休克患者NT-proBNP与液体复苏量的相关性研究  

Relationship between NT-proBNP and Fluid Resuscitation Volume in Patients with Septic Chock:An Retrospective Study

作　　者：王海曼[1] 国新杰 李甜 段美丽[1] WANG Haiman;GUO Xinjie;LI Tian;DUAN Meili(Department of Critical Care Medicine,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院重症医学科,北京市100050

出　　处：《中国分子心脏病学杂志》2023年第3期5433-5440,共8页Molecular Cardiology of China

基　　金：首都临床特色应用研究与成果推广项目(7171100001017064)。

摘　　要：目的 探讨感染性休克患者氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptides,NT-proBNP)升高时是否应该限制液体复苏。方法 回顾性分析2022年9月至2023年2月首都医科大学附属北京友谊医院重症医学科收治的121例感染性休克患者的临床资料,采用Spearman秩相关分析不同时间点NT-proBNP的相关性因素。同时在液体复苏后,根据NT-proBNP的变化分为升高组和非升高组,明确两种变化是否与液体复苏量相关。比较急性肾损伤(acute kidney injury,AKI)和非AKI患者,明确AKI是否会影响NT-proBNP的水平。结果 对比第28天存活的患者,除了液体复苏后第3天的NT-proBNP外,其他时间点的NT-proBNP值在死亡患者中均显著升高(P<0.05)。每个时间点的NT-proBNP绝对值均与APACHEⅡ评分相关(P<0.05),但与液体正平衡量不相关(P>0.05)。第1、2天液体复苏前后NT-proBNP差值与液体正平衡量相关(P<0.05),但无显著性差异(P>0.05),而且NT-proBNP升高组患者的死亡率要高于非升高组。AKI患者液体复苏后第1天NT-proBNP的绝对值显著高于非AKI患者(P<0.05),但两组其他时间点NT-proBNP比较,差异无统计学意义(P>0.05),AKI组的值均高于非AKI组。结论 感染性休克患者的NTproBNP与疾病严重程度相关、绝对值与液体正平衡量不相关。NT-proBNP的升高并不能说明要停止液体复苏,但过多的液体入量会导致NT-proBNP的升高。Objective To clarify whether elevated N-terminal pro-brain natriuretic peptides(NT-proBNP) indicates limiting the fluid volume of resuscitation in patients with septic shock.Methods In this retrospective observational study,we enrolled septic shock patients admitted to ICU from September 2022 to February 2023.All clinical,laboratory and survival data were collected.Spearman rank correlation analysis was used to explore the correlation factors of NT-proBNP.According to the different trends of NT-pro BNP after liquid resuscitation,patients were divided into two groups:the NT-proBNP elevated group and the NT-proBNP non-elevated group.Fluid resuscitation volume was compared between these two groups.Whether AKI could affect the level of NTpro BNP was also observed.Results Compared with survivors,except for the NT-proBNP on the 3rd day after fluid resuscitation(referred to as NT-proBNP3 in the text),the values of NT-proBNP at other time points were all significantly increased in the death on the 28th day(P<0.05).The absolute value of NT-proBNP at each time point was correlated with the APACHE Ⅱ score(P<0.05),but not with the positive liquid balance(P>0.05).The variation in NT-proBNP before and after liquid resuscitation on the first and second days was correlated with the positive balance of liquid(P<0.05).Although there was no significant difference(P>0.05),the mortality rate of patients with elevated NT-proBNP was higher than that of the non-elevated group.The NT-proBNP on the first day after liquid resuscitation,which was referred to as NT-proBNP1,was significantly higher in patients with AKI than that in patients without(P<0.05).Although there was no significant difference(P>0.05),the AKI group had higher NT-proBNP values indeed.Conclusions In critically ill patients with septic shock,the higher the severity of disease,the higher the value of NT-proBNP.The elevation of NT-proBNP does not indicate that fluid resuscitation should be stopped;but excessive liquid intake will lead to the increase of NT-proBNP.

关 键 词：感染性休克 NT-PROBNP 液体复苏 疾病预后 

分 类 号：R459.7[医药卫生—急诊医学]