[脑钠肽与有创血流动力学参数的相关性及其在非心源性休克患者预后中的价值]

[The correlation between brain natriuretic peptide and invasive hemodynamic parameters and their value in prognosis of patients with noncardiac shock].

作者信息

Wang Xi, Wang Ping, Li Hong-fei, Song Jia-zhi, Leng Ning-han, Wang Xin-kai, Li Xue-lian, Shen Qin, Huang Xian, Yang Jin, Li Jie-ying, Zou Jun, Zhang Jing, Chen Yan-chun, Diao Hua-ying

机构信息

Number Five People's Hospital of Chengdu, Chengdu, Sichuan, China.

出版信息

Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2012 Jan;24(1):54-6.

PMID:22248754

Abstract

OBJECTIVE

To examine the correlation between the plasma level of brain natriuretic peptide (BNP) and the hemodynamic parameters collected through Swan-Ganz flowing balloon catheter procedure in patients with noncardiac shock, in order to evaluate the potential for BNP to be used as prognostic indicator.

METHODS

The plasma BNP and invasive hemodynamic parameters data [central venous pressure (CVP), pulmonary arterial pressure (PAP), pulmonary capillary wedge pressure (PCWP), and cardiac output (CO)] were collected from 21 noncardiac shock patients received Swan-Ganz catheterization throughout a continuous surveillance for 3 days. The BNP, CVP, PAP, PCWP, CO in survivors (n = 8) and non-survivors (n = 13) were compared and the correlation between the value of BNP and the invasive hemodynamic parameters were analyzed using multiple regression.

RESULTS

The mean value of BNP (ng/L) was significantly higher in non-survivors (708.06 ± 242.58 vs. 317.05 ± 140.21, P < 0.05). In day 1, no significant difference was found in any hemodynamic parameters between non-survivors and survivors. But in day 3, the non-survivors were found to have significantly higher CVP (mm Hg, 1 mm Hg = 0.133 kPa: 13.64 ± 4.00 vs. 9.92 ± 1.26, P < 0.05) and lower CO (L/min: 4.61 ± 2.06 vs. 6.95 ± 1.28, P < 0.05). The differences in PAP (mm Hg: 20.84 ± 8.48 vs. 16.82 ± 4.97) and PCWP (mm Hg: 13.60 ± 5.71 vs. 12.72 ± 4.98) remained insignificant (both P > 0.05) between the two groups. The correlation between BNP and the invasive hemodynamic parameters was modest there was no correlation between BNP and CVP, PAP, PCWP, CO (r = 0.157, 0.306, 0.229, -0.269, P = 0.16, 0.25, 0.09, 0.12).

CONCLUSIONS

In patients with shock, both plasma BNP and invasive hemodynamic examination showed certain prognostic value. But in noncardiac shock cases, the increased BNP did not correlate with heart function, therefore it could not replace the Swan-Ganz catheter data to guide the treatment in these patients.

摘要

目的

探讨非心源性休克患者血浆脑钠肽（BNP）水平与经Swan - Ganz漂浮导管测得的血流动力学参数之间的相关性，以评估BNP作为预后指标的潜力。

方法

收集21例接受Swan - Ganz导管插入术的非心源性休克患者连续3天的血浆BNP及有创血流动力学参数数据[中心静脉压（CVP）、肺动脉压（PAP）、肺毛细血管楔压（PCWP）和心输出量（CO）]。比较存活者（n = 8）和非存活者（n = 13）的BNP、CVP、PAP、PCWP、CO，并采用多元回归分析BNP值与有创血流动力学参数之间的相关性。

结果

非存活者的BNP平均值（ng/L）显著更高（708.06±242.58对317.05±140.21，P<0.05）。第1天，非存活者与存活者之间的任何血流动力学参数均无显著差异。但在第3天，发现非存活者的CVP显著更高（mmHg，1 mmHg = 0.133 kPa：13.64±4.00对9.92±1.26，P<0.05），而CO更低（L/min：4.61±2.06对6.95±1.28，P<0.05）。两组之间PAP（mmHg：20.84±8.48对16.82±4.97）和PCWP（mmHg：13.60±5.71对12.72±4.98）的差异仍无统计学意义（P均>0.05）。BNP与有创血流动力学参数之间的相关性较弱，BNP与CVP、PAP、PCWP、CO之间均无相关性（r = 0.157、0.306、0.229、 - 0.269，P = 0.16、0.25、0.09、0.12）。