脓毒症休克心肌顿抑严重程度判断的临床研究

Clinic study on evaluation of severity of sepsis shock patients with myocardium stunning

目的探讨脑钠肽(BNP)、心肌钙蛋白I(cTnI)、血乳酸及急性生理及慢性健康状况评分Ⅱ(APACHEⅡ评分)在脓毒症休克心肌顿抑严重程度判断中的应用价值。方法 31例确诊脓毒症休克患者,入院后1h内抽血查BNP、cTnI、血乳酸,并进行APACHEⅡ评分,以后分别在开始治疗后6、24h监测上述指标。观察患者的最终预后,比较存活组和死亡组上述指标入院时的差异;分别比较不同预后组内各时间点上述指标的差异。结果 31例患者,死亡13例,存活18例,死亡率为41.9%。死亡组入院时各项指标数值均明显高于存活组[BNP:(3401.1±1710.2)pg/Lvs(1947.2±1319.5)pg/L,P=0.008;cTnI:(9.4±4.7)ng/Lvs(5.1±4.4)ng/L,P=0.012;血乳酸:(10.8±4.9)mmol/Lvs(7.1±4.5)mmol/L,P=0.027;APACHEⅡ评分:29.4±5.7vs22.1±8.8,P=0.006]。死亡组患者中,治疗6h上述指标与入院时比较差异无统计学意义(P均>0.05),治疗后24hBNP[(4757.9±2044.4)pg/Lvs(3401.1±1710.2)pg/L,P=0.011]、血乳酸[(12.4±3.2)mmol/Lvs(8.8±4.9)mmol/L,P=0.031]、APACHEⅡ评分(34.6±6.1vs29.4±5.7,P=0.029)均明显高于入院时(P均<0.05),cTnI差异无统计学意义(P>0.05)。存活组患者中,治疗6h[BNP:(1125.2±563.3)pg/Lvs(1947.2±1319.5)pg/L;cTnI:(2.1±1.4)ng/Lvs(5.1±4.4)ng/L;血乳酸:(4.4±2.7)mmol/Lvs(7.1±4.5)mmol/L;A-PACHEⅡ评分:15.5±7.9vs22.1±8.8]、24h[BNP:(578.1±345.5)pg/Lvs(1947.2±1319.5)pg/L;cTnI:(0.9±0.5)ng/Lvs(5.1±4.4)ng/L;血乳酸:(2.4±1.3)mmol/Lvs(7.1±4.5)mmol/L;APACHEⅡ评分:10.4±2.8vs22.1±8.8]各项指标均较入院时明显降低,差异有统计学意义(P均<0.05)。结论 BNP、cTnI、血乳酸和APACHEⅡ评分可反映脓毒症休克患者心肌顿抑的严重程度,预测患者预后,进一步可据此建立相关的脓毒症休克患者心肌顿抑严重程度评估系统。

Objective To explore the value of brain natriuretic peptide （BNP）, Cardiac Troponin I （cTnI）, blood lactate and APACHE 11 score which used to evaluat the severity of sepsis shock patients with myocardium stunning. Methods Data of 31 patients with sepsis shock were collceted, and BNP, cTnI,blood lactate were monitored and APACHE I1 score were scored in 1, 6 and 24 h respectively. All of these indicators were compared between death group and survival group in dif- ferent points-in-time respectively; These indicators also were compared among diferent points-in-time in death group and survival group respectively. Results In 31 patients, 13 cases of them were died and 18 cases of them were survived. All of these indicators in death group were significantly higher than that in survival group [BNP：（3 401.1±1 710.2） pg/L vs （1 947.2±1 319.5） pg/L, P = 0.008 ; cTnI ： （9.4±4.7） ng/L vs （5.1±4.4） ng/L, P = 0.012 ; blood lactate ： （10.8±4.9） mmol/L vs （7.1±4.5） mmol/L, P = 0.027; APACHE Ⅱ score：29.4±5.7 vs 22.1±8.8,P = 0.006]. In death group, there had no significantly difer- ence between 1 h and 6 h points-in-time （all ofP 〉 0.05）; there had significantly diference between 1 h and 24 h points- in-time for BNP[（4 757.9±2 044.4） pg/L vs （3 401.1±1 710.2） pg/L, P = 0.011], blood lactate[（12.4±3.2） mmol/L vs （8.8±4.9） mmol/L, P = 0.031] and APACHE I~ score [34.6±6.1 vs 29.4±5.7, P = 0.029], but not in cTnI （P 〉 0.05）. In survival group, There had significantly droping in all of these indicators compared among 1 h, 6 h and 24 h points-in-time respec- tively [BNP： （1 125.2±563.3） pg/L vs （1 947.2±1 319.5） pg/L;cTnI： （2.1±1.4） ng/L vs （5.1±4.4） ng/L;blood lactate： （4.4±2.7） mmol/L vs （7.1±4.5） mmol/L;APACHE II score： 15.5±7.9 vs 22.1±8.8] for 1 h and 6 h; BNP：（578.1±345.5） pg/L vs （1 947.2±1 319.5） pg/L ; cTnI ： （0.9±0.5） ng/L vs （5.1±4.4） ng/L; blood lactate ： （2.4±1.3） mmol/L vs （7.1±4.5） mmol/L; APACHE Ⅱ score： 10.4±2.8 vs 22.1±8.8 for 6 h and 24 h] all of P 〈 0.05. Conclusion BNP, cTnl,blood lactate and APACHE Ⅱscore may be used to evaluat the severity of sepsis shock patients with myocardium stunning and predict outcome of the patients. A evaluation system would be created based on these indicators for evaluating the severity of them.