摘要
目的探讨N-末端脑钠肽前体（NT-proBNP）对休克患者血流动力学及预后的评估价值。方法将45例入住中心ICU的休克患者分为心源性休克组和非心源性休克组，根据临床结局分为存活组和死亡组。使用热稀释法计算心脏血流动力学指标。记录患者入选24h APACHEⅡ评分。采用罗氏Elecsys2010电化学发光分析仪和NT-proBNP诊断试剂盒检测血清NT-pmBNP水平。结果所有患者血清NT-proBNP的中位数水平2987pg／mL，心源性休克组NT-proBNP明显高于非心源性休克组（P〈0.05），死亡组NT-proBNP明显高于存活组（P〈0.01）。NT-proBNP取自然对数后，它与肺毛细血管楔压（PCWP）（r=0.134，P〉0.05）和心脏指数（r=0.097，P〉0.05）均无明显相关性。NT-proBNP是ICU休克患者死亡的独立危险因素（OR值15.8，95％可信区间2.1－132.7，P=0.005）。结论ICU中休克患者NT-proBNP与血流动力学指标均无明显相关性，但它是ICU休克患者死亡的独立危险因素，预测死亡风险的价值优于APACHEⅡ评分，故其定量检测可能对休克患者的预后评价起到一定的作用。
Objective To evaluate the predictive value of N - terminal pro - brain natriuretic peptide（NT - proBNP） for shock patients in ICU. Methods 45 patients with shock in the ICU were divided into cardiac shock group and non - cardiac shock group, and were followed up for 28 days and then assigned to survival group and non - survival group respectively. The hemodynamic indexes were calculated with thermodilution method, and Acute Physiology and Chronic Health Evaluation Ⅱ score were also recorded. To apply the eleetroehemiluminescence immunoassay on Elecsys 2010 to quantitatively detect serum NT - proBNP. Results The median level of NT - proBNP in all patients were 2987 pg/mL. The level of cardiac shock group and non - survival group were significantly higher than those in non - cardiac shock group and survival group （P 〈0.05 and P 〈0.01 respectively）. There was no correlation between the natural logarithm of NT - proBNP and PCWP （r=0.134 ,P 〉 0.05） , so was cardiac index （r=0.097,P 〉0.05）. The level of NT- proBNP were independent risk factors of death in shock patients（OR 15.8, 95% CI 2.1 - 132.7 ,P=0.005）. Conclusion Although there was no correlation be- tween the level of NT - proBNP and hemodynamic index, the level of NT - proBNP can independently predict the death in shock patients in ICU and is superior to APACHE Ⅱ score. NT - proBNP may play a role in evaluating the prognosis of those patients.
出处
《中国急救医学》
CAS
CSCD
北大核心
2009年第11期990-992,共3页
Chinese Journal of Critical Care Medicine
