血NT-proBNP联合血流动力学监测对感染性休克患者预后的评估价值

Value of serum NT-proBNP combined with hemodynamic indexes in assessment of prognosis of patients with septic shock

目的 探讨血N端脑钠肽前体(NT-proBNP)联合重症超声血流动力学动态监测对感染性休克患者预后的评估价值。方法 选取2018年2月-2020年5月邹城市人民医院102例感染性休克患者,通过重症超声监测治疗前、治疗后6、24、48 h血流动力学参数[心输出量(CO)、心脏指数(CI)、每搏输出量(SV)],检测同时间血NT-proBNP水平,根据治疗后7 d预后情况分为生存组55例与死亡组47例,分析治疗过程中血流动力学监测联合血NT-proBNP与患者预后的关系。结果 102例感染性休克患者共培养出病原菌117株,其中革兰阳性菌23.08%、革兰阴性菌69.23%、真菌7.69%;生存组治疗前及治疗后6、24、48 h血流动力学指标CO、CI、SV水平均高于死亡组,血NT-proBNP水平低于死亡组(P<0.05);治疗前、治疗后6、24、48 h血流动力学指标联合血NT-proBNP水平预测患者预后受试者工作特征曲线(ROC)曲线下面积分别为0.817、0.825、0.837、0.928高于各项指标单独检测(P<0.05);治疗后48 h重症超声血流动力学监测联合血NT-proBNP预后预测效能高于治疗前、治疗后6、24 h(P<0.05)。结论 重症超声血流动力学监测CO、CI、SV水平降低,血NT-proBNP水平升高可作为感染性休克疾病不良预后的预测的标志物,动态观察其变化有助于感染性休克患者的预后评估。

OBJECTIVE To explore the value of serum N-terminal pro-brain natriuretic peptide(NT-proBNP) combined with dynamic monitoring of severe ultrasound hemodynamics in assessment of prognosis of the patients with septic shock. METHODS A total of 102 patients with septic shock who were treated in Zoucheng People’s Hospital from Feb 2018 to May 2020 were enrolled in the study. The hemodynamic parameters [cardiac output(CO), cardiac index(CI), stroke volume(SV)] were monitored by severe ultrasound before the treatment and after the treatment for 6 h, 24 h and 48 h. the levels of serum NT-proBNP were detected at the same time points. The patients were divided into the survival group with 55 cases and the death group with 47 cases according to the prognosis 7 days after the treatment, and the relationship between the monitoring of hemodynamic indexes combined with serum NT-proBNP during the treatment and the prognosis was observed. RESULTS Totally 117 strains of pathogens were isolated from the 102 patients with septic shock, 23.08% of which were gram-positive bacteria, 69.23% were gram-negative bacteria, and 7.69% were fungi. The hemodynamic indexes CO, CI and SV levels of the survival group were significantly higher than those of the death group before the treatment and after the treatment for 6, 24 and 48 hours, the serum NT-proBNP levels of the survival group were lower than those of the death group(P<0.05). The areas under receiver operating characteristic(ROC) curves of the hemodynamic indexes combined with serum NT-proBNP were respectively 0.817, 0.825, 0.837 and 0.928 in prediction of prognosis of the patients before the treatment and after the treatment for 6, 24 and 48 hours, significantly higher than those of single index(P<0.05);the efficiency of the monitoring of severe ultrasound hemodynamics combined with serum NT-proBNP in prediction of prognosis was significantly higher after the treatment for 48 hours than before the treatment and after the treatment for 6 and 24 hours(P<0.05). CONCLUSION The decline of the severe ultrasound hemodynamic indexes CO, CI and SV and the rise of serum NT-pro BNP level may be used as the markers for prediction of adverse prognosis of the patients with septic shock, and the dynamic monitoring of the indexes may facilitate the assessment of prognosis of the septic shock patients.