急性颅脑损伤致脑心综合征患者NT-proBNP的改变及其意义

Changes of Serum NT-proBNP Level in Patients with Cerebral Cardiac Syndrome Induced by Acute Craniocerebral Injury During Operation Period

目的:探讨急性颅脑损伤所致脑心综合征患者在围手术期中血清氨基末端脑钠肽前体(NT-proBNP)的意义及其与心电图(EKG)表现、心肌酶谱等的关系。方法:急性颅脑损伤致脑心综合征的患者95例,根据格拉斯哥昏迷评分(Glasgow co-ma scale,GCS)及脑损伤部位决定是否采取手术,从而将其分为手术组和对照组。手术组患者入院即刻即接受手术治疗。所有患者入院即刻、24h、72h、7d行心电图检查,同时采集静脉血并检测NT-proBNP、肌钙蛋白I和心肌酶谱。手术组患者术后24h内头颅CT复查。结果:(1)手术组患者入院72h心电图及NT-proBNP异常的比例明显低于对照组(P<0.05);(2)手术组术后心肌损伤特征性标记物CK-MB及NT-proBNP较术前显著降低(P<0.05);(3)两组中,GCS评分越低的患者,其NT-proBNP水平越高。结论:对急性颅脑损伤所致脑心综合征患者进行手术干预可以使NT-proBNP高峰前移,由此可减轻患者的心肌损害,降低心脏并发症的发生率;NT-proBNP与GCS评分的相关性提示NT-proBNP可以作为病情严重程度的评估指标。

Objective：To investigate the relationships of NT-proBNP, EKG and myocardial enzymes in cerebral cardiac syndrome（CCS） induced by acute craniocerebral injury. Methods：A total of 95 patients with CCS induced by acute craniocerebral injury have been enrolled. According to Glasgow coma scale （GCS） and the imaging findings, they were divided into operation group and non-operation group. At the time of admission to hospital immediately, as well as 24h, 72h and 7d after admission, electrocardiogram （ECG） was performed, and at the same time venous blood samples were collected for the detection of serum NT-proBNP, cardiac troponin I and myocardial enzyme spectrum. Head CT was performed in operation group at 24 h after operation. Results： （1）In the operation group, the percent of patients with ECG and NT proBNP abnormalities was significantly lower than that in the control group at 72 h（P〈0.05）;（2）After operation CK-MB and NT-proBNP levels were significantly lower （P〈0.05） than before operation in operation group; （3）The lower the GCS score was, the higher the level of NT proBNP was. ConcLusions： Operation intervention can make the NT-proBNP peak forward, improve myocardial damage, reduce the incidence of serious heart complications. NT-proBNP can be used to assess illness severity.