中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2014年
11期
816-820
,共5页
林笑女%姜晓霞%程青虹%刘超%张霞
林笑女%薑曉霞%程青虹%劉超%張霞
림소녀%강효하%정청홍%류초%장하
脓毒症%心室功能障碍,左%超声心动
膿毒癥%心室功能障礙,左%超聲心動
농독증%심실공능장애,좌%초성심동
Sepsis%Ventricular dysfunction,left%Echocardiography
目的 探讨经胸壁超声心动图(TTE)、B型钠尿肽(BNP)诊断脓毒症患者左心室舒张、收缩功能不全的应用价值.方法 采用前瞻性临床观察研究,收集脓毒症组患者90例和对照组患者30例,所有患者在入院后1、2、3、5、7d通过TTE记录左室射血分数(LVEF)、二尖瓣口舒张早期最大流速(E)与心房收缩期最大流速(A)的比值(E/A),检测血清BNP水平;同时记录各组患者性别、年龄、心率、平均动脉压(MAP)、白细胞计数(WBC)、APACHEⅡ及28 d病死率.结果 脓毒症组LVEF、E/A明显低于对照组,BNP明显高于对照组(均P=0.000);LVEF、E/A随时间呈先降低后回升的趋势,且E/A早于LVEF开始降低,BNP随时间呈先增高后回落的趋势;LVEF与E/A呈正相关(r =0.670,P=0.00),BNP与LVEF、E/A呈负相关(r1=-0.733,P1=0.00;r2=-0.929,P2=0.00);当BNP≥536.3 ng/L时,诊断脓毒症左心室收缩功能不全的敏感度为84.4％,特异度为68.7％;当BNP ≥505.0 ng/L时,诊断脓毒症左心室舒张功能不全的敏感度为56.0％,特异度为97.4％.结论 运用TTE技术检查发现,相比于左心室收缩功能不全,脓毒症患者左心室舒张功能不全出现更早,恢复更晚,脓毒症收缩功能不全可能与舒张功能不全有关;BNP可能参与调节脓毒症左心室舒缩功能不全,与舒张功能不全的严重程度关系更密切;运用TTE技术联合血清BNP监测脓毒症患者心功能的动态变化必要可行.
目的 探討經胸壁超聲心動圖(TTE)、B型鈉尿肽(BNP)診斷膿毒癥患者左心室舒張、收縮功能不全的應用價值.方法 採用前瞻性臨床觀察研究,收集膿毒癥組患者90例和對照組患者30例,所有患者在入院後1、2、3、5、7d通過TTE記錄左室射血分數(LVEF)、二尖瓣口舒張早期最大流速(E)與心房收縮期最大流速(A)的比值(E/A),檢測血清BNP水平;同時記錄各組患者性彆、年齡、心率、平均動脈壓(MAP)、白細胞計數(WBC)、APACHEⅡ及28 d病死率.結果 膿毒癥組LVEF、E/A明顯低于對照組,BNP明顯高于對照組(均P=0.000);LVEF、E/A隨時間呈先降低後迴升的趨勢,且E/A早于LVEF開始降低,BNP隨時間呈先增高後迴落的趨勢;LVEF與E/A呈正相關(r =0.670,P=0.00),BNP與LVEF、E/A呈負相關(r1=-0.733,P1=0.00;r2=-0.929,P2=0.00);噹BNP≥536.3 ng/L時,診斷膿毒癥左心室收縮功能不全的敏感度為84.4％,特異度為68.7％;噹BNP ≥505.0 ng/L時,診斷膿毒癥左心室舒張功能不全的敏感度為56.0％,特異度為97.4％.結論 運用TTE技術檢查髮現,相比于左心室收縮功能不全,膿毒癥患者左心室舒張功能不全齣現更早,恢複更晚,膿毒癥收縮功能不全可能與舒張功能不全有關;BNP可能參與調節膿毒癥左心室舒縮功能不全,與舒張功能不全的嚴重程度關繫更密切;運用TTE技術聯閤血清BNP鑑測膿毒癥患者心功能的動態變化必要可行.
목적 탐토경흉벽초성심동도(TTE)、B형납뇨태(BNP)진단농독증환자좌심실서장、수축공능불전적응용개치.방법 채용전첨성림상관찰연구,수집농독증조환자90례화대조조환자30례,소유환자재입원후1、2、3、5、7d통과TTE기록좌실사혈분수(LVEF)、이첨판구서장조기최대류속(E)여심방수축기최대류속(A)적비치(E/A),검측혈청BNP수평;동시기록각조환자성별、년령、심솔、평균동맥압(MAP)、백세포계수(WBC)、APACHEⅡ급28 d병사솔.결과 농독증조LVEF、E/A명현저우대조조,BNP명현고우대조조(균P=0.000);LVEF、E/A수시간정선강저후회승적추세,차E/A조우LVEF개시강저,BNP수시간정선증고후회락적추세;LVEF여E/A정정상관(r =0.670,P=0.00),BNP여LVEF、E/A정부상관(r1=-0.733,P1=0.00;r2=-0.929,P2=0.00);당BNP≥536.3 ng/L시,진단농독증좌심실수축공능불전적민감도위84.4％,특이도위68.7％;당BNP ≥505.0 ng/L시,진단농독증좌심실서장공능불전적민감도위56.0％,특이도위97.4％.결론 운용TTE기술검사발현,상비우좌심실수축공능불전,농독증환자좌심실서장공능불전출현경조,회복경만,농독증수축공능불전가능여서장공능불전유관;BNP가능삼여조절농독증좌심실서축공능불전,여서장공능불전적엄중정도관계경밀절;운용TTE기술연합혈청BNP감측농독증환자심공능적동태변화필요가행.
Objective To explore the diagnostic value of transthoracic echocardiogram (TTE) and/ or plasma B-type natriuretic peptide (BNP) for left ventricular (LV) systolic dysfunction and/or LV diastolic dysfunction in septic patients.Methods In this prospective observational study,90 septic patients and 30 non-septic ones underwent serial TTEs to measure LV ejection fraction (LVEF) and blood flow velocity of mitral annulus during early diastole (E) and atrial contraction (A) ratio (E/A) within 24 h of admission,2,3,5 and 7 days.Enzyme-linked immunosorbent assay (ELISA) was used to detect the plasma levels of BNP simultaneously.Patient medical records were used to obtain the information of demographics,APACHE Ⅱ scores and 28-day survival rates.Results LVEF and E/A decreased significantly more in sepsis group (P =0.00) while BNP elevated in sepsis group (P =0.00).LVEF and E/A showed an initial drop and a subsequent rise.On the contrary,BNP increased and then decreased.There was a positive correlation between LVEF and E/A (r =0.670,P =0.00) while BNP level had a negative correlation with LVEF and E/A (r1 =-0.733,P1 =0.00; r2 =-0.929,P2 =0.00).Receiver operating characteristic (ROC) curve analysis showed that a cutoff point of BNP at 536.3 ng/L for diagnosing sepsis-induced LV systolic dysfunction had a sensitivity of 84.4％ and a specificity of 68.7％.When at 505.0 ng/L,the valves were 56.0％ and 97.4％ respectively.Conclusion TTE may uncover septic patients whose LV diastolic dysfunction occurs earlier and reverses later than systolic type.And it may also participate in systolic dysfunction.The levels of BNP,probably as an adjustment to LV function,are more closely aligned with the severity of septic LV diastolic dysfunction.The combined application of TTE and plasma BNP appears to be efficacious for dynamically assessing cardiac function in septic patients.
