心脏骤停患者心肺复苏成功后利钠肽水平变化与预后关系的研究

Relationship Between Plasma Level of B-type Natriuretic Peptide and Prognosis in Patients of Sudden Cardiac Arrest With Successful Cardiopulmonary Resuscitation

目的：检测血清B型利钠肽（BNP）水平在心脏骤停患者心肺复苏成功后不同时间点的变化，探讨血清BNP水平的变化与近期预后的关系。方法：检测60例患者心脏骤停心肺复苏成功后即刻、3h、12．24h的血清BNP水平，根据血清BNP水平分为3组，A组16例：为心肺复苏成功后即刻、3h、12～24h血清BNP水平一直〈200pg／ml的患者；B组22例：为心肺复苏成功后3h和12～24hBNP水平持续升高，且一直〉200pg／ml的患者；C组22例：为心肺复苏成功后3h和12-24hBNP水平持续升高，但12～24h较3h时降低的患者。三组患者均随访6个月。结果：随访6个月，A组患者无死亡，B组患者死亡11例，C组患者死亡3例，A组患者6个月生存率高于B组（x^2=11．337，P=0．001），A组和C组6个月生存率差异无统计学意义（x^2=2．330，P=0．127），B组生存率较C组生存率降低（x^2=7．435，P=0．006）。结论：心脏骤停心肺复苏成功后患者的血清BNP水平持续增高，提示患者出现心功能不全，预后不良。为了改善患者近期预后，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 plasma level of B-type natriuretic peptide （BNP） and short term prognosis in patients of sudden cardiac arrest with successful cardiopulmonary resuscitation （CPR）. Methods：A total of 60 relevant patients were divided into 3 groups based on their plasma levels of BNE Group A, the patients with plasma level of BNP 〈 200 pg/ml at immediately, 3 hours and 12-24 hours after CPR, n=16. Group B, the patients with consistently increased BNP and at 3 hours, 12-24 hours after CPR and the BNP level 〉 200 pg/ml , n=22. Group C, the patients with obviously increased BNP at 3 hours after CPR, while at 12-24 hours after CPR, BNP level decreased to lower than 3 hours level, n=22. All patients were followed-up for 6 months to compare the mortality incidence among different groups. Results： There was no patient died in Group A, the mortality incidence in Group B was l I and in Group C was 3. The 6 months survival rate in Group A was higher than that in Group B （x^2 = 11.337, P=0.001）, the survival rates were similar between Group A and Group C （x^2 = 2.330, P=0.127）, and the survival rate in Group B was lower than that in Group C （x^2 =7.435, P= 0.006）. Conclusion： Consistently increased plasma level of BNP may imply heart failure in patients of sudden cardiac arrest with successful CPR, those patients could have poor short term prognosis. It is critical to improve the cardiac function and increasethe important organ infusion to make better recent clinical prognosis.