CAJ | 학술논문

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24 h 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-proBNP水平.结果所有患者血清NT-proBNP的中位数水平2987 pg/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.
목적 탐토N-말단뇌납태전체(NT-proBNP)대휴극환자혈류동역학급예후적평고개치.방법 장45례입주중심ICU적휴극환자분위심원성휴극조화비심원성휴극조,근거림상결국분위존활조화사망조.사용열희석법계산심장혈류동역학지표.기록환자입선24 h APACHEⅡ평분.채용라씨Elecsys2010전화학발광분석의화NT-proBNP진단시제합검측혈청NT-proBNP수평.결과 소유환자혈청NT-proBNP적중위수수평2987 pg/mL,심원성휴극조NT-proBNP명현고우비심원성휴극조(P＜0.05),사망조NT-proBNP명현고우존활조(P＜0.01).NT-proBNP취자연대수후,타여폐모세혈관설압(PCWP)(r=0.134, P＞0.05)화심장지수(r=0.097 , P＞0.05)균무명현상관성.NT-proBNP시ICU휴극환자사망적독립위험인소(OR치15.8,95%가신구간2.1～132.7,P=0.005).결론 ICU중휴극환자NT-proBNP여혈류동역학지표균무명현상관성,단타시ICU휴극환자사망적독립위험인소,예측사망풍험적개치우우APACHEⅡ평분,고기정량검측가능대휴극환자적예후평개기도일정적작용.
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 di-vided 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 electrochemiluminescence immunoassay on Elecsys 2010 to quantitatively de-tect 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 pa-tients(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.