中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2013年
10期
584-588
,共5页
刘丹%王波%康焰%朱达%尹万红
劉丹%王波%康燄%硃達%尹萬紅
류단%왕파%강염%주체%윤만홍
严重感染%感染性休克%N末端B型钠尿肽前体%经食道超声心动图%心功能
嚴重感染%感染性休剋%N末耑B型鈉尿肽前體%經食道超聲心動圖%心功能
엄중감염%감염성휴극%N말단B형납뇨태전체%경식도초성심동도%심공능
Severe sepsis%Septic shock%N-terminal pro-B-type natriuretic peptide%Transesophageal echocardiography%Cardiac function
目的 探讨血浆N末端B型钠尿肽前体(NT-proBNP)水平对严重感染/感染性休克患者心功能的评估价值.方法 采用前瞻性研究方法,选择44例无基础心脏疾患的严重感染/感染性休克患者,用经食道超声心动图(TEE)评价患者入ICU后1、3、7d的左、右心功能,同时间点检测血浆NT-proBNP、肌酸激酶同工酶质量(CK-MBmass)、肌钙蛋白T(cTnT)和乳酸水平,分析影响患者血浆NT-proBNP变化的因素,评价NT-proBNP与心功能指标的相关性.结果 44例严重感染/感染性休克患者28 d病死率为47.73％.死亡组(21例)患者入ICU后1、3、7d血浆NT-proBNP水平明显高于存活组(23例)患者[ng/L:10112(855～35000)比4116(185 ～ 28437),Z=-2.622,P=0.009;13811(1127 ～ 35000)比899(116～35000),Z=-3.459,P=0.000;6786(398 ～ 35000)比623(98 ～4118),Z=-3.001,P=0.003].采用非条件logistic回归分析或线性回归分析显示,入ICU后1d的乳酸(t=2.420,P=0.020)及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分(t=3.482,P=0.001),7d的左室射血分数(LVEF,t=-2.326,P=0.029)是血浆NT-proBNP水平升高的独立影响因素.依LVEF水平将患者分为两组,入ICU 7 d时心功能不全(LVEF＜0.50,8例)组血浆NT-proBNP水平明显高于心功能正常(LVEF≥0.50,17例)组[ng/L:1231(398 ～5000)比513(98～10047),Z=-1.831,P=0.047].结论 严重感染/感染性休克患者入ICU 7 d的血浆NT-proBNP水平升高提示其左心室收缩功能受损.
目的 探討血漿N末耑B型鈉尿肽前體(NT-proBNP)水平對嚴重感染/感染性休剋患者心功能的評估價值.方法 採用前瞻性研究方法,選擇44例無基礎心髒疾患的嚴重感染/感染性休剋患者,用經食道超聲心動圖(TEE)評價患者入ICU後1、3、7d的左、右心功能,同時間點檢測血漿NT-proBNP、肌痠激酶同工酶質量(CK-MBmass)、肌鈣蛋白T(cTnT)和乳痠水平,分析影響患者血漿NT-proBNP變化的因素,評價NT-proBNP與心功能指標的相關性.結果 44例嚴重感染/感染性休剋患者28 d病死率為47.73％.死亡組(21例)患者入ICU後1、3、7d血漿NT-proBNP水平明顯高于存活組(23例)患者[ng/L:10112(855～35000)比4116(185 ～ 28437),Z=-2.622,P=0.009;13811(1127 ～ 35000)比899(116～35000),Z=-3.459,P=0.000;6786(398 ～ 35000)比623(98 ～4118),Z=-3.001,P=0.003].採用非條件logistic迴歸分析或線性迴歸分析顯示,入ICU後1d的乳痠(t=2.420,P=0.020)及急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分(t=3.482,P=0.001),7d的左室射血分數(LVEF,t=-2.326,P=0.029)是血漿NT-proBNP水平升高的獨立影響因素.依LVEF水平將患者分為兩組,入ICU 7 d時心功能不全(LVEF＜0.50,8例)組血漿NT-proBNP水平明顯高于心功能正常(LVEF≥0.50,17例)組[ng/L:1231(398 ～5000)比513(98～10047),Z=-1.831,P=0.047].結論 嚴重感染/感染性休剋患者入ICU 7 d的血漿NT-proBNP水平升高提示其左心室收縮功能受損.
목적 탐토혈장N말단B형납뇨태전체(NT-proBNP)수평대엄중감염/감염성휴극환자심공능적평고개치.방법 채용전첨성연구방법,선택44례무기출심장질환적엄중감염/감염성휴극환자,용경식도초성심동도(TEE)평개환자입ICU후1、3、7d적좌、우심공능,동시간점검측혈장NT-proBNP、기산격매동공매질량(CK-MBmass)、기개단백T(cTnT)화유산수평,분석영향환자혈장NT-proBNP변화적인소,평개NT-proBNP여심공능지표적상관성.결과 44례엄중감염/감염성휴극환자28 d병사솔위47.73％.사망조(21례)환자입ICU후1、3、7d혈장NT-proBNP수평명현고우존활조(23례)환자[ng/L:10112(855～35000)비4116(185 ～ 28437),Z=-2.622,P=0.009;13811(1127 ～ 35000)비899(116～35000),Z=-3.459,P=0.000;6786(398 ～ 35000)비623(98 ～4118),Z=-3.001,P=0.003].채용비조건logistic회귀분석혹선성회귀분석현시,입ICU후1d적유산(t=2.420,P=0.020)급급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분(t=3.482,P=0.001),7d적좌실사혈분수(LVEF,t=-2.326,P=0.029)시혈장NT-proBNP수평승고적독립영향인소.의LVEF수평장환자분위량조,입ICU 7 d시심공능불전(LVEF＜0.50,8례)조혈장NT-proBNP수평명현고우심공능정상(LVEF≥0.50,17례)조[ng/L:1231(398 ～5000)비513(98～10047),Z=-1.831,P=0.047].결론 엄중감염/감염성휴극환자입ICU 7 d적혈장NT-proBNP수평승고제시기좌심실수축공능수손.
Objective To evaluate plasma N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels as a marker of cardiac function during severe sepsis and septic shock.Methods A prospective study was conducted,and 44 patients without history of heart diseases but suffering from severe sepsis and septic shock underwent the transesophageal echocardiography(TEE)to obtain data about left and right ventricular function on 1,3,7 days in intensive care unit(ICU).At the same time,blood samples were collected to measure the levels of plasma NT-proBNP,quality of creatine kinase isoenzyme(CK-MBmass),troponin T(cTnT)and lactate.The factors affecting plasma NT-proBNP levels in patients with severe sepsis and septic shock were analyzed,and correlation between NT-proBNP and cardiac function indexes were evaluated.Results Of 44 patient with severe sepsis and septic shock,21 cases died in 28 days,with the mortality rate of 47.73％.The plasma NT-proBNP values on 1,3,7 days in ICU of 21 non-survivors were obviously higher than those of 23 survivors[ng/L:10 112(855-35000)vs.4 116(185-28437),Z=-2.622,P=0.009;13811(1127-35000)vs.899(116-35000),Z=-3.459,P=0.000;6 786(398-35000)vs.623(98-4118),Z=-3.001,P=0.003].Non-conditional logistic regression analysis and linear regression analysis,plasma lactate(t=2.420,P=0.020)and acute physiology and chronic health evaluation system Ⅱ(APACHE Ⅱ)score(t=3.482,P=0.001)on day 1,and left ventricular ejection fraction(LVEF,t=-2.326,P=0.029)on day 7 showed that they were independent affecting factors for plasma NT-proBNP levels.Patients were subdivided into two groups based on LVEF.It was found that the plasma NT-proBNP values in abnormal group(LVEF＜0.50,n=8)were significantly higher than those in normal group(LVEF≥0.50,n=17)on day 7[ng/L:1231(398-5000)vs.513 (98-10047),Z=-1.831,P=0.047].Conclusion Plasma NT-proBNP levels on day 7 in ICU could reflect the left ventricular systolic dysfunction in patients with severe sepsis and septic shock.
