降钙素原及N末端钠尿肽前体在老年脓毒性休克病情评估的临床应用研究

The Clinical application of condition assessment of Procalcitonin and N-terminal brain natriuretic peptide in elderly septic shock

目的探讨血浆降钙素原(PCT)及N末端钠尿肽前体(N-proBNP)在老年脓毒症休克患者病情中的临床预测价值。方法选取本院2010年5月至2012年5月ICU病房收治的重症脓毒症休克期患者98例为研究对象,根据患者入院后28d内的生存状况将其分为复苏成功组(A组)28例、病情恶化或复苏无效组(B组)38例及死亡组(C组)32例,对比分析三组患者入院治疗1d、3d、5d、7d后血浆PCT及N-proBNP水平的差异,同时记录三组急性呼吸窘迫综合征(ARDS)发生率、急性肺损伤评分(Murray)、健康状况系统评分II(APACHE II)及器官功能障碍Marshall评分。结果与A组相比,B组及C组ARDS发生率、Murray评分、APACHE II评分、Marshall评分、PCT及N-proBNP水平显著升高,而C组各指标则高于B组,两两比较差异有统计学意义(P<0.05)。A组患者入院第5d后血浆PCT及N-proBNP水平显著低于入院治疗1d及3d水平,同时低于B、C组,差异有统计学意义(P<0.05)。结论老年脓毒性休克期患者血浆PCT及N-proBNP水平越高,其预后越差。血浆PCT及N-proBNP水平可作为预测老年脓毒性休克期患者病情转归的指标。

Objective To investigate plasma procalcitonin （PCT） and the N-terminal brain natriuretic peptide （N- proBNP） in elderly patients with septic shock,the predictive value of the clinical condition. Methods 98 cases were se- lected for the study,according to the patient＇s survival with in 28 d after admission conditions will be divided into suc- cessful resuscitation group （A） 28 cases, disease progression or recovery ineffective group （B group） 38 cases and death group （C group） 32 cases,comparative analysis of three groups of patients hospitalized 1 d,3 d,5 d,7 d after PCT and N-proBNP plasma level differences while recording three groups with acute respiratory distress syndrome （ARDS） incidence of acute lung injury score （Murray） score,health system score II （APACHE II）score and organ dysfunction Marshall score. Results Compared with group A, B and C group the incidence of ARDS, Murray score, APACHE II score, Marshall score, PCT and N-proBNP levels were significantly elevated in group C than in group B of the indicators are pairwise the difference was statistically significant （P^0.05）. A group of patients after admission 5d PCT and N- proBNP＇plasma levels were significantly lower hospitalization 1 d and 3d levels, while lower than B, C group, the differ- ence was statistically significant （P%0.05）. Conclusion Elderly patients with septic shock and N-proBNP plasma PCT levels higher,the worse the prognosis. PCT and N-proBNP plasma levels as a predictor of elderly patients with septic shock indicators of disease outcome.