血浆脑钠肽水平监测对严重感染及感染性休克患者心脏功能评估及预后的价值探究

The Cardiac Function Assessment and Prognostic Value of BNP Level Monitoring for Patients with Severe Infection and Septic Shock

目的探讨血浆脑钠肽水平监测对严重感染及感染性休克患者心脏功能评估及预后的价值。方法选择2013年1月至2014年1月北京市垂杨柳医院重症监护病房收治的50例严重感染及感染性休克患者,以集束化的治疗方式进行治疗,根据死亡与否分为死亡组(36例)及存活组(14例),观察患者的血浆脑钠肽、左心室射血分数(LVEF)及其他指标。结果存活组急性生理及慢性健康评分(APACHEⅡ)评分高于死亡组[(29±6)分比(20±5)分],差异有统计学意义(P<0.05);心功能不全组血浆脑钠肽水平和病死率均显著高于心功能正常组[(1267±400)ng/L比(762±296)ng/L,41.7%(10/24)比15.4%(4/26)],差异有统计学意义(P<0.05);在存活组患者中,血浆脑钠肽水平升高组(n=26)在重症病房的住院时间高于正常组(n=10)[(22.6±7.6)d比(14.0±5.6)d],差异有统计学意义(P<0.05)。结论血浆脑钠肽水平可以检测严重感染及感染性休克患者的心脏功能,医师需要根据相应的动态变化对治疗方案进行调整,从而帮助患者改善预后。

Objective To investigate the cardiac function assessment and prognostic value of Brain natriuretie peptide（BNP） level monitoring for patients with severe infection and septic shock. Methods Total of 50 patients with severe infection and septic shock were chosen in Chuiyangliu Hospital from Jan. 2013 to Jan. 2014. All patients were treated with Bundling treatment ,and were divided into death group（ 36 cases） and survival group （ 14 cases） according to treatment outcome. The plasma BNP,left ventricular ejection fraction （LVEF） and other indicators of the patients were observed. Results The acute physiology and chronic health evaluation（APACHE） /I score of the survival group was higher than the death group[ （29 ± 6） scores vs （20 ± 5 ） scores ], the difference was statistically significant （ P 〈 0. 05 ） ; the BNP level and case fatality rate in patients with heart failure group was significantly higher than normal cardiac function group [ （ 1267± 400 ） ng/L vs （ 762 ± 296 ） ng/L,41.7 % （ 10/24 ） vs 15.4% （ 4/26 ） ], the difference was statistically significant （P 〈 0.05 ）. In survival patients, the length of stay in ICU was significantly longer in BNPelevatedgroup（n=26） than that in BNP normal group（n=10） [（22.6 ±7.6） d vs （14.0 ± 5.6） d ] , the difference was statistically significant （ P 〈 0.05 ）. Conclusion Plasma BNP levels can detect the heart function of severe infection and septic shock patients, and physicians need to make appropriate adjustments of treatment programs according to the dynamic changes to improve the prognosis.