无创血流动力学监测联合脑钠素检测对呼吸困难危重患者的应用价值

Diagnostic value of the non-invasive hemodynamic monitor system combine with the natriuretic peptide measurement in critical patients with dyspnea

目的探讨无创血流动力学监测联合脑钠素(BNP)检测对呼吸困难危重患者的诊断价值。方法对43例呼吸困难危重症患者进行BNP检测和无创血流动力学监测。将呼吸困难者分为心衰组27例(左、右心衰亚组),非心衰组16例。结果心衰组BNP明显高于非心衰组,差异有统计学意义(P<0.05)。左、右心衰亚组血浆BNP比较差异无统计学意义(P>0.05)。心衰组所致呼吸困难中心输出量(CO)、心功能指数(CI)、每搏输出量(SV)、心搏指数(SI)、加速度指数(ACI)、左室做功指数(LCWI)明显低于非心衰组,差异均有统计学意义(P<0.05)。而体血管阻力(SVR)、预射血期(PEP)、收缩时间比率(STR)则明显高于非心衰组,差异均有统计学意义(P<0.05)。右心衰所致呼吸困难患者胸腔积液量(TFC)高于左心衰及非心衰组,差异有统计学意义(P<0.05)。心衰组心率(HR)和平均动脉压(MAP)与非心衰组比较差异无统计学意义(P>0.05)。结论无创血流动力学监测联合BNP检测能为临床呼吸困难的危重症患者早期诊断和治疗提供可靠依据。

Objective To investigate the diagnostic value of the natriuretic peptide measurement combine with non- invasive hemadynamic monitor system in critical patients with dyspnea. Methods 43 critical patients of with dyspnea were divided into groups according to differental clinical diasnosis ,27 patients diagnisis cardiogenic dyspnea group（ left and right heart failure groups） and non-cardiogenic dyspnea groups of 16 cases,those were meaured by the natriuretic peptide and monitored by non-invasive hemadynamic monitor system. Results The natriuretic peptide level of the patients whose dyspnea were caused by heart failure were obviously higher than those of patients whose dyspnea were caused by non-heart failure （P 〈 0. 05 ）. There was no statistical difference between dyspnea induced by left heart failure group and right heart failure group （ P 〉 0. 05 ）. The Parameters such as cardiac output （ CO ）, cardiac index （ CI）, strike volume （ SV ） , strike index （ SI ）, acceleration index （ACI） and left cardiac work index（LCWI） of heart failure group were significantly lower than the parameters of dyspnea induced by non-heart failure group （ P 〈 0.05 ）. But parameters of systemic circulation peripheral vascular resistance （ SVR ）, pre-ejection period （ PEP）, systolic time rate （STR） of heart failure groups were significantly higher than the parameters of non-heart failure group （P 〈 0.05 ）. Parameters heart rate （HR）, thorax fluid capacity （TFC）of right heart failure group were significantly higher than the others （ P 〈 0.05 ）. There were no statistical differences in the heart rate （HR） and mean arterial pressure（MAP） between cardiogenic dyspnea groups and non-cardiogenic dyspnea group （ P 〉 0.05 ）. Conclusion The non- invasive hemadynamic monitor system combine with the natriuretic peptide provide reliable evidence for clinical diagnosis and treatment for critical patients with dyspnea.