动态监测感染性休克患者B型钠尿肽的预后评价

Prognostic value of monitoring B-type natriuretic peptide and relation to hemodynamic changes in septic shock patients

目的探讨血浆B型钠尿肽(BNP)对感染性休克患者预后评估的意义,并评价BNP与感染性休克时机体血流动力学改变之间的关系。方法选择2015年1月至2016年12月苏北人民医院重症医学科收治的58例行机械通气的感染性休克患者,脉搏指示剂连续心排血量监测仪(PiCCO)持续监测心脏指数(CI)、每搏量指数(SVI)、全心舒张末期容积指数(GEDI)等血流动力学参数。入院后行急性生理学与慢性健康状况(APACHE II)评分和序贯器官衰竭(SOFA)评分,动脉血乳酸、BNP测定。根据患者入院后28天的生存状态分为存活组(36例)和死亡组(22例),比较两组BNP、APACHE II评分、SOFA评分、乳酸与预后进行分析,绘制受试者工作特征(ROC)曲线,评价BNP对感染性休克患者预后的预测价值。结果死亡组入院时BNP水平明显高于存活组(P=0.009)。存活组第1、2、3天血浆BNP水平呈明显的下降趋势;而死亡组患者治疗后BNP水平未见下降,两组BNP水平比较差异有统计学意义。根据ROC曲线分析显示:BNP的ROC曲线下面积(AUC)为0.679(P=0.031),对预后评价的灵敏度和特异度分别为66.7%、76.7%。结论 BNP水平与感染性休克患者病情严重程度及预后相关,BNP可用于感染性休克患者的预后评价。

Objective To explore the prognostic value of plasma B-typc natriuretic peptide （BNP.） andrelationship with hemodynamic change in patients with septic shock. Methods A retrospectClinical data of 58 mechanically ventilated septic shock patients admitted in the Department of Critical Care Medicine inSube People’s Hospital fromjanuary 201 5 toDcccmbcr 2016 were analyzed. Cardiac index （CD,stroke volume index CSV!） and globat end diastolic volume index （GEDI） were detected by pulse indicator continuous cardiac output （PiCCO） technology for 3 days. Acute Physiology andChronic Health Evaluation n （APACHE n ） score,sequential organ failure assessment （SOFA） score, arterial blood lactate levels （Lac） and BNP were conducted after admission. According to the 28-day mortality after admission in intensive care unit （ICU）, the patients were divided into survival group （ n =36） and death group （ n =22）. The BNP,APACHEn,SOFAand Lac in two groupswere analyzed,and their relationships and outcome were analyzed. The receiver operating characteristic （ROC） curve was plotted to assess the value of BNP for predicting the outcome. Results Three-day BNP kinetics demonstrated a decline trend over time in survival group while no downtrend was found in death group, and there was significant difference in plasma BNP levels between two groups. ROC curves demonstrated that the area under ROC curve（AUC） of BNP was 0. 679（ P =0. 031）. As the cutof point of BNP, the sensitivity and specificity of BNP predicting the survival of patients was 66. 7 % and 76.7%, respectively. Conclusion Scrum BNP could bea useful diagnostic indicator for septic shock. Prolonged BNP elevation and inability to reduce BNP after proper treat may imply incrrcascd mortality.