非心源性休克患者脑钠肽与血流动力学参数的相关性分析及两者预测预后的价值探讨

The correlation between brain natriuretic peptide and invasive hemodynamic parameters and their value in prognosis of patients with noncardiac shock

目的探讨非心源性休克患者血浆脑钠肽（BNP）水平与肺动脉漂浮导管（Swan—Ganz导管）所测得数据的相关性，以及与患者预后的关系。方法采用前瞻性对照研究方法，选择本院重症监护病房（ICU）21例非心源性休克患者，置入Swan—Ganz导管，连续3d测定中心静脉压（CVP）、肺动脉压（PAP）、肺毛细血管楔压（PCWP）、心排血量（co），同时进行血浆BNP定量检测；分析存活患者（8例）和死亡患者（13例）BNP及CVP、PAP、PCWP、CO的差异。采用多元回归分析法分析BNP与CVP、PAP、PCWP、CO的相关性。结果死亡患者人院时血浆BNP浓度（ng／L）显著高于存活患者（708．06±242．58比317．05±140．21，P〈0．05）：而两组患者血流动力学参数无明显差异。治疗3d后，死亡患者CVP（mmHg，1mmHg=0．133kPa）显著高于存活患者（13．64±4．00比9．92±1．26，P〈O．05），而CO（L／min）显著低于存活患者（4．61±2．06比6．95±1．28，P〈0．05），死亡患者和存活患者PAP（mmHg）、PCWP（mmHg）无明显差异（PAP：20．84±8．48比16．82±4．97，PCWP：13．60±5．71比12．72±4．98，均P〉0．05）。多元回归分析显示，BNP与CVP、PAP、PCWP、CO均无明显相关性（r值分别为0．157、0．306、0．229、-0．269，P值分别为0．16、0．25、0．09、0．12）。结论血浆BNP和Swan—Ganz导管监测血流动力学参数对休克患者病情和预后的评估均有一定价值；但在非心源性休克患者中，BNP增高不能作为反映心功能的指标，不能替代Swan—Ganz导管用于指导治疗。

Objective To examine the correlation between the plasma level of brain natriuretic peptide （BNP） and the hemodynamic parameters collected through Swan-Ganz flowing balloon catheter procedure in patients with noncardiac shock, in order to evaluate the potential for BNP to be used as prognostic indicator. Methods The plasma BNP and invasive hemodynamic parameters data [central venous pressure （CVP）, pulmonary arterial pressure （PAP）, pulmonary capillary wedge pressure （PCWP）, and cardiac output （CO）1 were collected from 21 noncardiac shock patients received Swan-Ganz catheterization throughout a continuous surveillance for 3 days. The BNP, CVP, PAP, PCWP, CO in survivors （n = 8 ） and non-survivors （n=13 ） were compared and the correlation between the value of BNP and the invasive hemodynamic parameters were analyzed using multiple regression. Results The mean value of BNP （ng/L） was significantly higher in non-survivors （708.06 ± 242.58 vs. 317.05 ±140.21, P〈0.05）. In day 1, no significant difference was found in any hemodynamic parameters between non-survivors and survivors. But in day 3, the non-survivors were found to have significantly higher CVP （mm Hg, 1 mm Hg=0.133 kPa： 13.64 ± 4.00 vs. 9.92 ± 1.26, P〈0.05） and lower CO （L/min： 4.61 ±2.06 vs. 6.95 ± 1.28, P〈0.05）. The differences in PAP （mm Hg： 20.84 ± 8.48 vs. 16.82 ± 4.97） and PCWP （mm Hg： 13.60 ± 5.71 vs. 12.72 ±4.98） remained insignificant （both P〉 0.05 ） between the two groups. The correlation between BNP and the invasive hemodynamic parameters was modest there was no correlation between BNP and CVP, PAP, PCWP, CO （r=0.157, 0.306, 0.229, -0.269, P=0.16, 0.25, 0.09, 0.12）. Conclusions In patients with shock, both plasma BNP and invasive hemodynamic examination showed certain prognostic value. But in noncardiac shock cases, the increased BNP did not correlate with heart function, therefore it could not replace the Swan-Ganz catheter data to guide the treatment in these patients.