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目的探讨血浆B型脑钠肽(B-type natriuretic peptide,BNP)水平升高持续时间对脓毒性休克患者预后判断的价值。方法收集入住院ICU 150例脓毒性休克患者的BNP水平升高持续时间、急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ评分)、初始血浆BNP水平和预后的相关资料。根据预后分为存活组(110例)和死亡组(40例),比较两组患者BNP水平升高持续时间、APACHEⅡ评分、初始血浆BNP水平的差异;以BNP水平升高持续时间分为A组(<48h,48例)、B组(48~96h,56例)和C组(>96h,46例),比较三组患者病死率的差异。结果各组入住ICU时APACHEⅡ评分、初始血浆BNP水平比较差异均无统计学意义(P>0.05);存活组BNP水平升高持续时间为(38.2±15.1)h,明显低于死亡组(65.5±16.4)h(P<0.05);C组病死率(52.2%)明显高于A、B两组(10.4%与19.6%)(P<0.01)。结论 BNP水平升高持续时间可用于评估脓毒性休克患者治疗效果和预后。
Objective To investigate the prognostic value of plasma B-type natriuretic peptide (BNP) in patients with septic shock. Methods The duration of elevated BNP, acute physiology and chronic health status score Ⅱ (APACHEⅡ), initial plasma BNP level and prognosis were collected in 150 ICU patients admitted to hospital. According to the prognosis, the patients were divided into survival group (n = 10) and death group (n = 40). The duration of elevated BNP, APACHEⅡscore and the initial plasma BNP level were compared between the two groups. (48 cases, 48 cases), group B (48 ~ 96 hours, 56 cases) and group C (96 hours, 46 cases). The differences of mortality among the three groups were compared. Results There was no significant difference in APACHEⅡscore and initial plasma BNP level between the two groups (P> 0.05). The duration of BNP level in survival group was (38.2 ± 15.1) h, which was significantly lower than that in the death group (65.5 ± 16.4) h (P <0.05). The mortality in group C (52.2%) was significantly higher than that in group A and B (10.4% vs 19.6%, P <0.01). Conclusions The duration of elevated BNP levels can be used to assess the efficacy and prognosis of patients with septic shock.