CAJ | 학술논문

目的评估B型利钠肽(BNP)的动态变化预测腹部大手术后液体负荷过度的可能性.方法 2009年2月至2010年11月,对江汉大学附属医院普外科105例接受择期腹部大手术患者检测围手术期血浆BNP水平的动态变化,并与年龄、术后液体正平衡量进行比较.结果所有患者术后BNP均升高,其中32例患者BNP峰值≥100 ng/L,另73例BNP峰值＜100 ng/L.5例患者术后发生急性肺水肿.在术后各时间点,BNP峰值≥100 ng/L与峰值＜100 ng/L患者及发生肺水肿患者液体正平衡量差异均无统计学意义(均P＞0.05).BNP峰值≥100 ng/L患者术后应用利尿剂后尿量显著增加[ (280±55) ml/h比(82 +22) ml/h,P＜0.05)],而BNP峰值＜100 ng/L患者则无明显变化[(95±18)ml/h比(89±24)ml/h,P＞0.05)].单变量分析发现BNP的变化与年龄及伴随心肺疾病呈正相关(R ＝0.87,P＝0.006)而与液体正平衡量无显著相关性(R ＝0.43,P＝0.080).当同时以年龄和液体正平衡量为变量进行多变量回归分析时,液体正平衡量与BNP无相关性(R＝0.38,P＝0.120)而年龄仍与BNP呈正相关(R ＝0.59,P＝0.020).BNP于术后12 h达峰值,而体重及液体正平衡量于术后18 ～24 h达到峰值.结论术后BNP的动态变化与年龄呈正相关,BNP显著高于正常时提示液体负荷过度；提前出现的BNP变化的峰值可作为液体正负平衡转折点的预测指标之一.
목적 평고B형리납태(BNP)적동태변화예측복부대수술후액체부하과도적가능성.방법 2009년2월지2010년11월,대강한대학부속의원보외과105례접수택기복부대수술환자검측위수술기혈장BNP수평적동태변화,병여년령、술후액체정평형량진행비교.결과 소유환자술후BNP균승고,기중32례환자BNP봉치≥100 ng/L,령73례BNP봉치＜100 ng/L.5례환자술후발생급성폐수종.재술후각시간점,BNP봉치≥100 ng/L여봉치＜100 ng/L환자급발생폐수종환자액체정평형량차이균무통계학의의(균P＞0.05).BNP봉치≥100 ng/L환자술후응용이뇨제후뇨량현저증가[ (280±55) ml/h비(82 +22) ml/h,P＜0.05)],이BNP봉치＜100 ng/L환자칙무명현변화[(95±18)ml/h비(89±24)ml/h,P＞0.05)].단변량분석발현BNP적변화여년령급반수심폐질병정정상관(R ＝0.87,P＝0.006)이여액체정평형량무현저상관성(R ＝0.43,P＝0.080).당동시이년령화액체정평형량위변량진행다변량회귀분석시,액체정평형량여BNP무상관성(R＝0.38,P＝0.120)이년령잉여BNP정정상관(R ＝0.59,P＝0.020).BNP우술후12 h체봉치,이체중급액체정평형량우술후18 ～24 h체도봉치.결론 술후BNP적동태변화여년령정정상관,BNP현저고우정상시제시액체부하과도；제전출현적BNP변화적봉치가작위액체정부평형전절점적예측지표지일.
Objective To evaluate the values of serum level of B type natriuretic peptide level (BNP) in the prediction of fluid overloading after major abdominal operations.Methods The levels of BNP were dynamically monitored in 105 patients during peri-operative period from February 2009 to November 2010.Then comparisons were made with age and the volume of positive fluid balance.Results A post-operative elevation of BNP was observed in all cases.Among them,the peak level of BNP exceeded 100 ng/L in 32 patients while a normal peak level of BNP was found in 73 patients.Congestive heart failure (CHF) was diagnosed in 5 patients.At every single time point,the volume of positive fluid balance showed no significant difference among the peak level of BNP ＜ 100 ng/L,≥ 100 ng/L and CHF patients ( all P ＞0.05).In the group of peak level of BNP ≥100 ng/L,the patients received post-operative diuretic and the urine volume increased significantly [ ( 280 + 55 ) ml/h vs ( 82 + 22 ) ml/h,P ＜ 0.05 ].However,in the group of the peak level of BNP ＜ 100 ng/L,the urine volume showed no difference after dosing of diuretic [ (95 ± 18)ml/h vs (89 ±24) ml/h,P ＞0.05].Single variance analysis showed that the elevated level of BNP was associated with age and concurrent cardiopulmonary diseases(R ＝0.87,P ＝0.006) but not with the volume of positive fluid balance ( R ＝ 0.43,P ＝ 0.080).And multiple variance analysis showed the similar results (R＝0.59,P ＝0.020,R＝0.38,P＝0.120).In all cases,the levels of BNP peaked at 12 hours post-operation.However,body weight and the volume of positive fluid balance peaked at 18 - 24 hours post-operation.Conclusion The post-operative level of BNP is associated with age.And a highly elevated level of BNP may predict the occurrence of fluid overloading.An early peak of BNP value may be used as a cut-off point of positive and negative fluid balances.