B型钠尿肽在心肺复苏患者中变化的临床意义

Change of B-type natriuretic peptide in peripheral blood during cardiopulmonary resuscitation and its clinical significance

目的探讨B型钠尿肽(BNP)检测在心肺复苏(CPR)患者中的临床意义。方法95例心搏骤停后CPR患者,依据复苏效果分为三组,A组:CPR 30 min,无效死亡;B组:复苏成功,自主循环建立≥2 h,但最终死亡;C组:复苏成功,存活出院;对照组(D组):30例健康成年体检者。于CPR开始(0 h)、3、6、12 h和24 h留取静脉血,检测BNP水平,比较各组患者该指标的动态变化。结果在CPR初期,A、B、C三组BNP无明显激活,与D组比较差异无统计学意义(P>0.05);B组于CPR 3 h激活程度与C组接近,于CPR 6 h显著激活,较C组明显升高,差异有统计学意义(P<0.05),并持续至24 h;C组于CPR 3 h激活,6 h达峰值,24 h降至较低水平。结论CPR过程中,BNP的激活呈动态变化,患者CPR后出现了心功能不全。BNP的早期激活对机体是一种保护性反应,BNP大量持续表达提示CPR患者心力衰竭加重,预后不良。治疗心功能不全、提高心排血量、改善重要脏器血液灌注可以提高CPR成功率。

Objective To explore the relationship between the level of B-type natriuretic peptide（BNP） in peripheralblood and the prognosis of cardiopulmonary resuscitation（CPR）.Methods A total of 95 victims with sudden cardiac arrest who received CPR were divided into three groups.The victims who didn＇t regain heartbeats were enrolled into Group A,those who experienced a return of spontaneous circulation for over two hours but finally died into Group B,and those who survived into Group C.Control group consisted of 30 healthy volunteers.The expression of BNP activation in peripheral blood was determined at the time of 0-,3-,6-,12-,and 24-hour after CPR.Results The expression of BNP activation showed no significant differences at the beginning of CPR in all the groups.In Group C,it began to increase at 3-hour,reached peak at 6-hour,and then decreased nearly to normal at 24-hour.No significant difference was found before 6-hour between Group B and C.In Group B,the BNP concentration significantly increased after successful CPR,and kept at a high level till 24-hour.Conclusion The expression of BNP activation at the initial and developing stage may indicate heart failure in those with CPR.At the early stage of CPR,BNP has protective effects on the human body,but the massive expression of BNP activation is associated with serious heart failure,which induced a high mortality of victims with CPR.