多发伤患者早期N末端脑利钠肽前体动态变化及其伤情评估价值

The dynamic change of NT-proBNP in patients with multiple injury at the early stage after trauma and its evaluation value of injury severity

目的:探讨多发伤患者早期血浆N末端脑利钠肽前体(NT-proBNP)的动态变化及其与合并心肌损害的关系,同时评价其伤情评估价值。方法:收集2005年8月～2007年4月间多发伤住院患者15例,按照APACHEⅡ评分将患者分为重伤组(≥15分)7例与一般伤害组(<15分)8例。分别于入院后第1、3、5、7天进行NT-proBNP与cTnI动态检测。结果:多发伤患者第1天血浆NT-proBNP与APACHEⅡ评分呈正相关(r=0.601,P<0.001)。两组患者第1、3、5、7天NT-proBNP及cTnI比较均具有统计学意义,其中重创组升高更为显著(组间比较,P<0.01)。结论:多发伤患者NT-proBNP动态变化可能与心肌损伤有关,NT-proBNP可以用来进行多发伤患者早期伤情评估。

Objective：To investigate the relation between the dynamic change of N-terminal proBNP （Brain Natriuretic Peptide） and the complic myocardial injury in patients with multiple injury at the early stage,and assess the evaluation value of injury severity. Methods：Fifteen hospitalized patients with multiple injury were collected from Aug 2005 to Apr 2007. All patients were divided into two groups：serious injury group （≥ 15 point） and control group （〈15 point） according to APACHE Ⅱ scores. Plasma NT-proBNP and cTnI were detected at the 1st,3rd,5th,7th day after admission. Results：There was a positive correlation between plasma NT-proBNP levels and APACHE Ⅱ scores at the 1st day in patients with multiple injury （r = 0. 601 ,P 〈 0.001）. The difference of NT-proBNP and cTnI between the two groups was statistically significant in the 1st, 3rd, 5th, 7th day, respectively. The levels of the two indexes in the serious injury group increased more striking than the control group （P 〈 0.01 ）. The mean values of plasma NT-pmBNP and cTnI both increased from the 1st day in two groups. In control group,the peaks of the mean values of plasma NT-proBNP and cTnI appeared at the 3rd day, then decented sequentially,and finally dropped back into the normal range at the 5th day. In serious injury group,the plasma level of NT-proBNP increased consistently until the 7th day,and the peak value appeared latter than the control group（at the 5th day）. But the value did not drop back into the normal range at the 7th day. Conclusion：The dynamic change of NT-proBNP in patients with multiple injury may be related to myocardial injury, but serious injury patients may be influenced by many factors. NT-proBNP could be used in evaluation of injury severity at the early stage after trauma.