脑钠肽联合无创血流动力学监测在老年呼吸困难鉴别诊断中的意义

Combined examination of brain natriuretic peptide and noninvasive hemadynamic monitor system in identifying elderly patients with dyspnea

目的 探讨脑钠肽联合无创血流动力学监测系统在老年呼吸困难鉴别诊断中的意义.方法 对22例正常健康老年人及53例老年呼吸困难患者进行血浆脑钠肽的检测和无创血流动力学监测.根据病史、临床表现、相关检查以及治疗的反应,将呼吸困难分为两组,其中心衰所致呼吸困难27例和肺源性呼吸困难26例.结果 心衰所致呼吸困难患者脑钠肽、体血管阻力/阻力指数、预射血期、收缩时间比率明显高于肺源性呼吸困难患者和健康对照组,差异均有统计学意义（P〈0.01）.心衰所致呼吸困难患者左室射血分数、心输出量/心脏指数、每搏输出量/每搏指数、加速度指数、左室射血时间、左室做功/做功指数、速度指数明显低于肺源性呼吸困难患者和健康对照组,差异均有统计学意义（P〈0.01）.脑钠肽联合无创血流动力学监测,可明显提高心衰诊断的敏感性、特异性.结论 通过血浆脑钠肽的检测并联合无创血流动力学监测系统监测相关参数,可为临床老年呼吸困难的鉴别及治疗提供可靠依据.

Objective To determine the clinical significance of combined examination of brain natriuretic peptide（BNP） and noninvasive hemadynamic monitor system in differential diagnosis of elderly patients with dyspnea. Methods We detected plasma BNP level of elderly patients with dyspnea （ n = 53 ） and elder of healthy （ n = 22 ） , and monitored all hemodynamic parameters provided by noninvasive hemadynamic monitor system simultaneously. The cases of dyspnea were divided into heart failure group（n = 27） and non-heart failure group（ n = 26 ） according to case history, physical examination, arterial blood gas analysis,D-dimer,electrocardiogram,X-ray,ultracardiogram,and the therapeutic effect. Results Plasma BNP levels and left ventricle ejection time（LVET） of dyspnea induced by heart failure group were significantly lower than those of dyspnea induced by non-heart failure group and elder of healthy（P 〈 0.01 ）. Parameters cardiac output/index （ CO/CI）, stroke volume/index （ SV/SI ）, acceleration index （ ACI）, left cardiac work/index （ LCW/LCWI）, velocity index （VI） of dyspnea induced by heart failure group were sig- nificantly lower than those of dyspnea induced by non-heart failure group and elder of healthy, the difference among the groups is significant in statistics （ P 〈 0.01 ）. But parameters of systemic circulation peripheral vascular resistance/index （ SVR/SVRI ）, pre-ejection period （ PEP）, systolic time rate （ STR ） of dyspnea induced by heart failure group were higher than the parameters of dyspnea induced by non-heart failure group and elder of healthy, the difference among the groups is significant in statistics （ P 〈 0.01 ）. The sensitivity and specificity were improvesd combined examination of noninvasive hemadynamic monitor system and compare to detecte BNP separately. Conclusions Combined examination of non-invasive hemadynamic monitor system and BNP provid reliable evidence for clinical diagnosis and treatment of elderly patients with dyspnea.