监测血清N末端B型脑钠肽前体水平指导停用主动脉内球囊反搏术时机的选择

Monitoring of serum NT-proBNP levels to predict the opportunity of weaning from intra-aortic balloon pumping

目的旨在通过监测血清N末端B型脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)水平变化指导选择主动脉内球囊反搏(intra aortic balloon pump,IABP)停用时机。方法回顾性分析2013年1月至2014年7月在沈阳军区总医院行IABP辅助心功能的患者173例,以停用IABP后48 h内患者是否发生不良事件(包括二次使用IABP、肺水肿、血流动力学不稳定需要增加正性肌力药物、紧急气管插管、恶性心律失常及心原性死亡)分为成功组(127例)和失败组(46例),记录并分析置入IABP前和停用IABP前每位患者的NT-proBNP水平变化及随访期间主要不良心脏事件(MACE,包括再发心肌梗死、心力衰竭再入院及心原性死亡)的发生情况。结果两组患者置入IABP前NT-proBNP水平(P=0.151)及其他临床特征比较,差异均无统计学意义(P>0.05)。成功组患者NT-proBNP水平停用IABP前较置入IABP前显著降低(P<0.001),而失败组患者则显著升高(P<0.001)。ROC曲线显示,当NT-proBNP水平停用IABP前升高到较置入IABP前增加47.56%时预测停用IABP失败的灵敏度和特异度最大。成功组患者MACE发生率显著低于失败组(34%比81%,P<0.001)。结论血清NT-proBNP水平降低对停用IABP具有临床指导意义,但血清NT-proBNP水平升高达47.56%,提示需要考虑更多的治疗措施。

Objective The aim of this study was to investigate the ability of serum N-terminal pro- brain natriuretic peptide （NT-proBNP） level to predict the success of weaning from IABP. Methods A retrospective review was performed on 173 patients who had used IABP in our department from Jan 2013 to Jul 2014. Changes in NT-proBNP level between baseline （before used of IABP） and cessation （just before cessation of IABP） were analyzed between the 2 groups of patients those who were successfully weaned off （n = 127） and those who were not successfully weaned off （n =46） for any reason （including a decision to use IABP again, pulmonary edema after cessation of IABP, unstable hemodynamics required increased use of inotropic agents, emergency intubation, malignant arrhythmia or death with in 48 hours after cessation of IABP） . The study has also recorded and analyzed the incidence of major adverse cardiovascular events （recurrence of myocardial infarction, readmission for heat failure or cardiac death） in both groups during （ 17. 3 ±4. 5） months of follow up. Results All the baseline clinical date showed no significant difference between the 2 groups （P 〉0.05） and the levels of NT-proBNP （P 〈0. 151） . There was no significant difference in the incidence of major adverse cardiovascular events between the successful and unsuccessful weaning groups （34% vs. 81%, P 〈0. 001 ） during follow up. There was a significant decrease in median NT-proBNP level between baseline and cessation in the successful weaning group （2/37. 0 pg/ml vs.1349.0 pg/ml, P 〈 0. 001 ） , and there was a significant increase in median NT-proBNP level between baseline and cessation in the unsuccessful weaning group （3071.5 pg/ml vs. 4590. 5 pg/ml, P 〈0. 01 ） . ROC curre study showed when NT-proBNP increased by 47.56% before IABP cessation compared to baseline would have a specificity of 0.64, and sensitioity of 0. 808 towards unsuccessful weaning （ 95 % CI 0. 585 -0. 843 ）. Conclusions Serum NT-proBNP levels were useful for predicting the success of weaning from IABP. If the serum NT-proBNP level increases by 47. 56% during weaning from IABP, more intense management should be considered.