CPR后早期血清B型钠尿肽水平及不同升高时间与预后的关系

Relationship of BNP and clinical CPR prognosis analyzed by serum BNP level and its dynamic changes during the early stage of CPR

目的检测血清B型钠尿肽（BNP）在心脏骤停心肺复苏（CPR）成功患者早期升高水平及不同时间的水平变化，并探讨其与近期预后的关系。方法分别检测60例CPR患者在CPR后即刻、3h和12～24h的血清BNP水平，并检测CPR后3h时左心室射血分数（LVEF）。根据血清BNP升高时间分为三组，A组：CPR后即刻、3h、12—24h血清BNP水平一直〈200ps／mL；B组：CPR后3h和12—24hBNP水平持续升高，且一直〉200pg／mL；C组：CPR后3h和12～24hBNP水平持续升高，但12—24h较3h时降低。随访三组患者6个月后的死亡情况。结果Spearman秩相关分析显示，CPR后3h血清BNP水平与LVEF呈负相关，CPR后3h血清BNP水平高表达组6个月无病生存时间低于BNP低表达组。随访6个月，B组患者的死亡情况明显高于A组与c组；C组患者死亡情况稍高于A组。结论CPR过程中血清BNP可在心室早期激活，并且呈动态变化，这对机体是一种保护性反应。但是，如果CPR患者血清BNP大量持续表达，提示CPR患者出现心功能不全，预后不良。CPR后早期血清BNP水平及变化趋势可有效预测患者心功能及近期临床预后。临床上为了改善CPR患者近期预后，治疗上应积极改善心功能不全，提高心排出量，改善重要脏器的血液灌注。

Objective To explore the relationship between the level of B - type natriuretic peptide （BNP） in peripheral blood and the recent clinical prognosis of cardiopulmonary resuscitation （CPR） . Methods A total of 60 victims with sudden cardiac arrest who received CPR were divided into three groups. The victims whose BNP levels are less than 200 pg/mL went into group A. Those whose BNP levels at the time of 12 -24 h after CPR are higher than the time of 0 h and 3 h after CPR went into group B, and those whose BNP levels at the time of 12 - 24 h after CPR are lower than the time of 0 h and 3 h after CPR went into group C. Left ventricular function （LVEF） was detected 3 h after CPR. These 60 cases were followed -up with ACS 6 months of mortality incidence. Results Spearman rank correlation analysis showed that the serum BNP level 3 h after CPR was negatively correlated with LVEF, 6 months of survival rates of the higher level serum BNP group 3 h after CPR were less than the BNP low expression group. 6 months of mortality incidence of group B was obviously higher than that of group A and group C; 6 months of mortality incidence of group C was slightly higher than that of group A. Conclusion The expression of BNP activation at the initial and developing stage may indicate heart failure in those with CPR. At the early stage of CPR, BNP has protective effects on the human body, but the massive expression of BNP activation is associated with serious heart failure, which induced a high mortality of victims with CPR.