脑利钠肽对非体外循环冠状动脉旁路移植术后撤机的预测价值

B-type natriuretic peptides for prediction of weaning failure from mechanical ventilation after off-pump coronary artery bypass grafting

目的探讨脑利钠肽(B-type natriuretic peptide,BNP)水平对于非体外循环冠脉搭桥(off-pump coronary ar-tery bypass grafting,OPCABG)术后撤机的预测价值。方法 2010年2月～2011年7月42例接受OPCABG手术患者术后入外科重症监护室(surgical intensive care unit,SICU)。根据术后带机时间将患者分为撤机失败组(>48h)和撤机成功组(<48h),术前常规进行心脏超声及BNP水平测定。比较两组患者术前基础情况、临床结局,分析BNP水平与临床参数的相关性,探讨撤机失败的危险因素。结果 42例患者中20例撤机失败,22例撤机成功。撤机失败组心脏超声结果显示左室舒张末容积(LVEDD)明显增大、左室射血分数(LVEF)降低(P值分别为0.021和0.009);心功Ⅲ/Ⅳ级患者数量、欧洲心脏手术风险评分系统(EuroSCORE)评分、BNP水平均明显高于撤机成功组(P值分别为0.029、0.014和0.012)。患者临床结局中,撤机失败组机械通气时间、住院时间、住ICU时间均明显高于撤机成功组(P值分别为0.000、0.009和0.014);BNP与心功III/IV级患者数量(r=0.701)、LVEF(r=-0.6)、带机时间(r=0.757)、住ICU时间(r=0.7)明显相关(P<0.05)。logistic回归分析发现BNP为撤机失败的独立危险因素(odds ratio,OR=1.004;95%CI 1.001～1.008)。结论 BNP水平与OPCABG患者的术前心功能,术后带机时间及住ICU时间明显相关,是预测OPCABG术后撤机失败的独立危险因素。

Objective To evaluate B-type natriuretic peptide （BNP） concentrations to predict weaning failure from mechanical ventilation（MV） after off-pump coronary artery bypass grafting（OPCABG）. Methods Prospective, observational study in the Surgical intensive care unit（SICU） recruited 42 patients on MV after OPCABG. They were divided into 2 groups as weaning failure group （MV 〉 48h）and weaning success group （MV 〈 48h）. Echocardiography and sampling for BNP were performed before the surgery. Comparing baseline characteristics and clinical outcomes of the both groups, analyzing correlations between BNP and clinical parameters and exploring the risk factor for weaning failure of these patients. Results 20 patients failed weaning of these 42 patients. Weaning failure group showed larger left ventricular end diastolic diameter （LVEDD） （ P = 0. 021 ）, lower left ventricular ejection fraction（LVEF） （P = 0. 009） in Echocardiography and significant more patients with New York Heart Association （NYHA） Ⅲ/Ⅳ （P = 0. 029 ）, higher European system for cardiac operative risk evaluation （EuroSCORE） （P = 0. 014） and BNP value （P = 0. 012） co,npared to weaning success group. Besides, weaning failure group had longer durations of MV, ICU and hos- pital length of stay （P = 0. 000,0. 009,0. 014 respectively） in clinical outcomes. BNP significantly correlated with number of pa- tients with NYHA Ⅲ/Ⅳ （ r = 0. 701 ）, LVEF （ r = 0.6）, days of MV （ r = 0. 757 ） and ICU length of stay （ r = 0. 7） （ P 〈 0.05 ）. Logistic regression analyses showed the preoperative BNP level was an independent risk factor for ventilation 〉 48 hours（odds rati- o, OR = 1. 004;95% CI 1. 001 ~ 1. 008）. Conclusion The baseline BNP level correlated with preoperative heart function, longer durations of MV and ICU stay after OPCABG. BNP can predict weaning failure as an independent risk factor.