急性失代偿充血性心力衰竭患者氨基端脑钠肽前体水平与血流动力学参数间的相关性分析

摘要

目的 通过对血氨基端B-型尿钠肽前体( NT-proBNP)水平、左室射血分数(LVEF)和左室舒张期末内径( LVEDd)与急性失代偿性心力衰竭患者的有创血流动力学指标进行相关性分析,评估NT-proBNP在急性失代偿性心力衰竭治疗监测中的意义.方法 连续入选我院重症监护病房急性失代偿性充血性心力衰竭(NYHAⅢ～Ⅳ)、LVEF＜40％、Swan Ganz导管检查肺毛细血管楔压(PCWP)≥13mmHg患者共32例.在植入Swan Ganz导管前8小时内,进行血NT-proBNP水平检测及超声心动图检查；冰盐水热稀释法连续测量平均肺动脉压(MPAP)、PCWP、系统血管阻力指数( SVRI)和心脏指数(CI)三次,并记录平均值.对NT-proBNP水平与LVEF、LVEDd及有创血流动力学指标进行线性相关性分析.结果LVEF、LVEDd与CI及PCWP之间无显著相关性；NT-proBNP与CI具有显著相关性(r=-0.356,P＜ 0.05),与PCWP无显著相关性；有创血流动力学指标中,MPAP,PCWP,SVRI与CI具有显著相关性(r=-0.358,r=-0.309,r=-0.576,P＜0.05),MPAP与PCWP具有显著相关性(r=-0.822,P＜0.05)；其它有创血流动力学参数间无显著相关性.结论 急性失代偿充血性心力衰竭患者的常用血流动力学指标中,仅NT-proBNP与CI具有显著相关性,NT-proBNP水平对监测血流动力学状态有重要意义.%Objective To determine the role of plasma N-terminal pro-B-type natriuretic peptide(NT-proBNP) in evaluating the therapeutic effects on acutely decompensated heart failure by analyzing the correlation of non-invasive function parameters, including NT-proBNP, left ventricular ejection fraction(LVEF) and left ventricular end diastolic diameter(LVEDd), with invasive hemodynamic parameters. Methods Totally 32 acutely decompensated chronic heart failure patients with NYHA Ⅲ～Ⅳ, LVEF<40%, and pulmonary capillary wedge pressure(PCWP)≥13mmHg, were enrolled. NT-proBNP, LVEF and LVEDd were detected within 8 hours before implanting Swan-Ganz catheter. Mean pulmonary arterial pressure(MPAP), PCWP, systemic vascular resistance index(SVRI) and cardiac index(CI) were recorded repeatedly for three times in the process of Swan-Ganz catheter performance. And the mean values were obtained. Linear correlation analysis was performed to determine the association of NT-proBNP, LVEF and LVEDd with invasive hemodynamic parameters. Results LVEF and LVEDd were not correlated with invasive hemodynamic parameters(CI and PCWP). NT-proBNP was correlated with CI significantly(r =-0.356, P < 0.05) instead of PCWP. The invasive hemodynamic parameters, including MPAP, PCWP, and SVRI were all correlated with CI(r=-0.358, -0.309 and -0.576 respectively, P<0.05). MPAP was correlated with PCWP(r = -0.822, P<0.05). No correlation was found between the other invasive heart function parameters(P > 0.05). Conclusions For the acutely decompensated heart failure patients, NT-proBNP is correlated with CI closely. NT-proBNP could play an important role in monitoring the hemodynamics.