B型钠尿肽前体联合急性生理和慢性健康状况评分Ⅱ在老年重症肺炎患者预后中的意义

Significance of N-terminal propeptide of B-type natriuretic peptide combined with acute physiology and chronic health evaluation Ⅱ score in prediction of prognosis of patients with severe pneumonia

目的探讨B型钠尿肽前体(NT-proBNP)水平联合急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)在预测老年重症肺炎患者预后中的意义。方法对2011年7月-2013年9月132例老年重症肺炎患者监测NTproBNP值,并进行APACHEⅡ评分,根据患者预后分为好转组和未愈组,分析NT-proBNP与APACHEⅡ评分在老年重症肺炎患者预后中的量化关系,并分析二者与危重患者ICU住院天数、机械通气时间、转归的关系。结果 132例患者死亡26例,病死率为19.7%;其中未愈组APACHEⅡ评分值和血清NT-proBNP浓度均明显高于好转组,差异有统计学意义(P<0.01);好转组患者的血清NT-proBNP浓度与患者ICU住院天数(r=0.7301)、机械通气时间(r=0.7932)呈正相关关系,不同住院天数组间比较差异有统计学意义;患者NT-proBNP水平与APACHEⅡ评分呈正相关。结论 NT-proBNP水平联合APACHEⅡ评分可协助预测老年重症肺炎患者ICU住院时长、机械通气时间、病死率等。

OBJECTIVE To explore the significance of N‐terminal propeptide of B‐type natriuretic peptide （ NT‐proBNP） combined with acute physiology and chronic health evaluation （APACHE）Ⅱ score in prediction of the prognosis of the elderly patients with severe pneumonia .METHODS A total of 132 elderly patients with severe pneumonia who were treated from Jul 2011 to Sep 2013 were recruited as the study objects ,the NT‐proBNP value was monitored ,the APACHE Ⅱ scoring was performed ;the patients were divided into the improvement group and the non‐cured group according to the prognosis of the patients ;the quantitative relationship between the NT‐proBNP and APACHE Ⅱ score and the prognosis of the two groups of elderly patients with severe pneumonia was observed ,and the correlation between the two and the length of ICU stay ,mechanical ventilation time ,and clinical outcomes was analyzed .RESULTS Of the 132 patients ,26 cases died with the mortality rate of 19 .7% .The A‐PACHE Ⅱ score and the serum NT‐proBNP concentration of the non‐cured group were significantly higher than those of the improvement group ,there was statistically significant difference（P〈0 .01） .The serum NT‐proBNP concentration of the patients in the improvement group was positively correlated with the length of ICU stay （r=0 .7301） and the mechanical ventilation time （r= 0 .7932） ,there was statistically significant difference in the length of hospital stay between the two groups ;the level of NT‐proBNP was positive correlated with the A‐PACHE Ⅱ score .CONCLUSION The NT‐proBNP combined with APACHE Ⅱ score can help to predict the length of ICU stay ,mechanical ventilation duration ,and prognosis .