严重脓毒症患者血浆B型脑钠肽水平与PICCO监测指标的相关性分析

摘要

Objective: To investigate the relationship between monitoring indicators of pulse-indicated continous cardiac output and the change of brain natriuretic plasma peptide(BNP)levels in severe sepsis patients. Methods:Twenty-eight severe sepsis patients admitted to intensive care unit (ICU) were divided into normal cardiac function group or abnormal cardiac function guoup through according to Doppler echocardiography test of examination. The levels of serum BNP were measured in both groups. The heart function indexes were monitored through transpulmonary thermodilution pulse-indicated continous cardiac output(PICCO) technique, compare with correlation between brain natriuretic peptide and monitoring indicators of pulse-indicated continous cardiac output. Results: BNP levels were significantly higher in abnormal cardiac function guoup compared with normal cardiac function group , the levels of serum BNP had significant negative correlation with cadiac function index(CFI) in two groups and positively correlated with extravascular lung water index(EVLWI) in abnormal cardiac function guoup,28-day mortality increased significantly in abnormal cardiac function guoup. Conclusions:The cardiac function could be reflectded by BNP levels in severe sepsis patients, BNP levels colud predict the extra-vascular lung water index in abnormal cardiac function patients.%目的:探讨严重脓毒症患者脉波指示剂连续心输出量(PICCO)监测指标与外周血脑钠肽(BNP)水平变化的关系以指导临床诊治.方法:收集严重脓毒症患者28例,入重症监护室(ICU)24 h按超声心动图检查心功能评估分为心功能正常组和心功能减退组,比较2组血浆BNP水平,并通过PICCO技术记录心功能指数(CFI)、外周血管阻力指数( SVRI)、全心舒张末期容量指数(GEDVI)、血管外肺水指数(EVLWI)和胸腔内血容积指数(ITBVI),比较其与血浆BNP水平相关性.结果:2组BNP均升高,但心功能减退组BNP升高明显,组间比较有显著差异.心功能减退组BNP与CFI呈负相关,与EVLWI呈正相关,与GEDVI,ITBVI,SVRI无显著相关.心功能正常组BNP仅与CFI呈负相关,与其他指标均无显著相关.心功能减退组28 d病死率显著升高.结论:BNP能够反映严重脓毒症患者心功能状态,在心功能减退组患者还可以间接反映血管外肺水的情况.