血浆钠尿肽对急性心力衰竭患者容量负荷评估的意义

摘要

Objective To analyze the correlation between plasma natriuretic peptide and capacity load assessment in patients with acute heart failure. Methods From October 2013 to October 2015, 120 cases of patients diagnosed with acute heart failure were divided into the capacity of liquid positive balance group (positive balance group, 40 cases) and liquid capacity negative balance group (negative balance group, 80 cases), according to the basis of the liquid capacity within 48 hours when the patients were admitted to the hospital. It was compared between the two groups clinical heart function improvement degree. They were observed with mean arterial pressure (MAP, mm Hg), average heart rate (HR, times/min), respiratory rate (R/min) and arterial blood gas analysis detection in patients with arterial blood lactate concentration (Lac, mmol/L) and plasma natriuretic peptide (BNP, pg/mL) between two groups of patients. There were a comparison with noninvasive entilator assisted ventilation/usage, within seven days of ventilator weaning rate, mortality, multiple organ injury score difference between the two groups. Pearson correlation were analyses the correlation between plasma natriuretic peptide and the capacity balance. Results Before treatment, there was no significant difference between the two groups in basic data (P>0.05). After 48h treatment, the levels of MAP in patients with negative balance capacity increased, HR, R, blood Lac, BNP levels than the capacity of positive equilibrium group significantly decreased, there was significant difference between the two groups (P<0.05). Negative balance in patients with mechanical ventilation using rate and MODS score of ventilator weaning rate within seven days, and the clinical mortality rates are positive balance capacity was decreased, there was significant difference between the tow groups (P<0.05). 48 h liquid loading is highly linear correlation with the plasma levels of BNP (r=0.603, P<0.05). Conclusion The 48 hour capacity load changes and plasma natriuretic peptide levels and clinical severity are related in the patients with acute heart failure, negative balance management liquid moderate helps to improve clinical outcomes in patients with acute heart failure.%目的：分析血浆钠尿肽水平变化对急性心力衰竭患者容量负荷评估的临床价值。方法选择2013年10月至2015年10月诊断急性心力衰竭患者120例，依据患者入院后48 h 内液体出入量平衡结果分为液体容量正平衡组（正平衡组，40例）与液体容量负平衡组（负平衡组，80例）。比较2组患者治疗48 h 后临床心脏功能改善程度，观察2组患者平均动脉压（MAP，mm Hg）、平均心率(HR，次/分钟)、呼吸频率(R，次/分钟)，动脉血气分析检测患者动脉血乳酸浓度（Lac，mmol/L），电化学发光法检测2组患者血浆钠尿肽（BNP，pg/mL）水平。比较2组患者无创/有创呼吸机辅助通气使用率、7 d 内呼吸机脱概率、临床病死率、多脏器损伤评分差异。Pearson 相关性分析血浆钠尿肽与容量平衡间相关性。结果治疗前，2组患者基础资料差异无统计学意义（P ＞0.05）。治疗48 h 后，容量负平衡组患者 MAP 水平上升，HR、R、血 Lac、BNP 水平较容量正平衡组明显降低，2组比较差异有统计学意义（P ＜0.05）。负平衡组患者呼吸机辅助通气使用率、7 d 内呼吸机脱概率、MODS 评分及临床病死率较容量正平衡组下降，2组比较差异有统计学意义（P ＜0.05）。48 h 液体负荷量与血浆 BNP 水平呈高度正直线相关（r=0.603，P ＜0.05）。结论急性心力衰竭患者48 h 容量负荷变化与血浆钠尿肽水平以及临床病情严重程度存在相关，适度的液体负平衡管理有助于急性心力衰竭患者临床预后改善。