摘要
目的观察不同病情程度脓毒症患者血清N末端前体脑尿钠肽(NT-pro BNP)和血流动力学指标的差异,并探讨血流动力学指标、NT-pro BNP和脓毒症病情程度的相关性。方法选取2013年1月至2016年6月中国石油天然气集团公司中心医院重症医学科首诊的94例脓毒症患者,根据入院时病情程度分为脓毒症33例(轻度组)、严重脓毒症31例(重度组)和脓毒症休克30例(休克组),并根据患者30 d内死亡情况分为死亡组35例和生存组59例,比较不同病情、不同预后效果患者间血清NT-pro BNP和血流动力学指标的差异,应用秩相关分析法对血清NT-pro BNP、血流动力学指标与脓毒症病情程度间的相关性进行分析。结果休克组患者的急性生理与慢性健康评分(APACHEⅡ)、序贯器官衰竭评估(SOFA)、30 d内死亡率、平均动脉压(MAP)、心指数(CI)、心率(HR)、二尖瓣舒张早期充盈峰速度E峰和舒张晚期充盈峰速度A峰比值(E/A)、左室射血分数(LVEF)、NT-pro BNP异常程度重于其他各组,重度组上述指标异常程度重于轻度组,三组间上述指标比较,差异均具有统计学意义(P<0.05);血清NTpro BNP、MAP、CI、HR与脓毒症病情程度评分有显著相关性(P<0.01);生存组和死亡组的年龄、血清NT-pro BNP、MAP、CI、HR指标比较差异均有统计学意义(P<0.05);COX生存分析结果显示年龄、血清NT-pro BNP、HR与病死率呈显著相关(P<0.01)。结论 CI、HR和血清NT-pro BNP及血流动力学指标是脓毒症疾病相关危险因素,其中年龄、血清NT-pro BNP、HR、MAP是脓毒症独立危险因素,可作为危险评估和预后预测的可靠性指标。
Objective To observe the differences of N terminal pro-B-type natriuretic peptide（NT-pro BNP）and hemodynamic indexes in patients with different severity of sepsis, and to discuss the correlation between hemodynamic indexes, NT-pro BNP and the severity of sepsis. Methods A total of 94 patients with sepsis who were first diagnosed in Department of Critical Care Medicine in Central Hospital of China Petroleum and Natural Gas Corporation from January 2013 to June 2016 were selected. According to the admission condition, they were divided into mild sepsis group（mild group, n=33）, severe sepsis group（severe group, n=31） and septic shock group（shock group, n=30）. According to the death situation in 30 d, they were divided into the death group（n=35） and survival group（n=59）. The difference of serum NT-pro BNP and hemodynamic index between different disease condition and different prognosis were compared. The correlation between serum NT-pro BNP, hemodynamic index and the severity of sepsis were analyzed by Rank correlation analysis. Results The abnormality in Acute Physiology and Chronic Health Evaluation（APACHEⅡ）, Sequential Organ Failure Assessment（SOFA）, 30 d mortality, mean arterial pressure（MAP）, cardiac index（CI）,heart rate（HR）, early diastolic mitral inflow peak velocity E and late diastolic filling peak velocity ratio（E/A）, left ventricular ejection fraction（LVEF）, NT-pro BNP were more serious in shock group than in the other groups, and in severe group than in the mild group. The differences among the three groups of above indicators were statistically significant（P〈0.05）. Serum NT-pro BNP, MAP, CI, HR were significantly correlated with sepsis severity score（P〈0.01）. The differences in age, serum NT-pro BNP, MAP, CI, HR between the survival group and death group were statistically significant（P〈0.05）. COX survival analysis showed that age, serum NT-pro BNP, HR and the mortality rate were significantly correlated（P〈0.01）. Conclusion CI,
出处
《海南医学》
CAS
2017年第9期1390-1394,共5页
Hainan Medical Journal
基金
河北省廊坊市科技支撑计划(编号:2016013023)
