呼吸困难患者血浆脑利钠肽论文.docx

呼吸困难患者血浆脑利钠肽论文【摘要】目的探讨呼吸困难患者的血浆脑利钠肽(BNP)水平与呼吸困难病因之间的相关性及临床意义。方法153例呼吸困难的患者分为三组:A组肺源性呼吸困难组51例;B组术后循环血量过多引发呼吸困难组46例;C组心肌收缩力障碍引发呼吸困难组56例检测其血浆BNP水平和超声心动图检查左室射血分数(LVEF)部分患者行漂浮导管监测血流动力学。结果153例呼吸困难患者的血浆BNP水平和左室射血分数(LVEF)分别是:A组为(178.25±45.43)pg/L、(0.61±0.07)pg/L;B组为(3545.58±1147.48)pg/L、(0.59±0.06)pg/L;C组为(10471.55±3599.23)pg/L、(0.32±0.11)pg/L。C组病人的血浆BNP浓度显着高于B及A组;而B组与A组EF值无明显差别血浆BNP浓度A组较B组显着增高。结论BNP的释放直接与心室容量负荷过度和心室收缩力障碍相关心室收缩力障碍似乎更能够引起血浆BNP水平升高。【关键词】心力衰竭;呼吸困难;循环血量;脑利钠肽;血流动力学Abstract:ObjectiveTodeterminethecorrelationbetweenthebloodlevelofBnatriureticpeptide(BNP)andhemodynamicalterationsandevaluatethediagnosticvalueofBNPinpatientswithdyspneaduetodifferentcauses.MethodsBNPlevelswereobtainedbyarapidimmunofluorescenceassayin153patientswithdyspneawhichweredividedintothreegroupsfirstgroupforlungdisease(51patients)secondforoverloadofcirculatorybloodvolume(46patients)andanotherforcardiogenicgroup(56patients).Hemodynamicparametersofallpatientsweredeterminedandleftventricularenddiastolicdiameters(LVEDD)weremeasuredwithechocardiogram.ResultsPulmonarycapillarywedgepressure(PCWPmmHg)was(8.20±2.60)inthefirstgroup(11.50±3.72)inthesecondgroupand(30.43±7.61)inthelastgroup.Centralvenouspressure(CVPmmHg)ofthreegroupswere(6.50±1.90)(20.95±4.11)and(15.27±4.96)respectively.BNP(pg/L)levelswere(178.25±45.43)(3545.58±1147.48)and(10471.55±3599.23)respectivelyandleftventricularejectionfraction(LVEF)were(0.59±0.06)(0.61±0.07)and(0.32±0.11).BNPlevel(918148±453125)pg/LofthegroupwithLVEDD≥60mmwasmuchhigherthanthatofthegroupwithLVEDD25次/min伴辅助呼吸肌参与的患者153例常规问诊、体格检查、心电图、胸部X线、超声心动图及同时测定血浆BNP水平。82例患者行漂浮导管检查穿刺锁骨下静脉插入漂浮导管至肺动脉分支测定休息时肺毛细血管嵌压(PCWP)和中心静脉压(CVP)。肺源性呼吸困难组经超声心动图检查无左、右心室增大左室射血分数(LVEF)>0.49。心衰诊断依据Framingham标准综合心脏超声等影像学和肺毛细血管嵌压(PCWP)等实验室检查以及病程中对治疗的反应等作出诊断心功能分级按照美国心脏病协会NYHA分级方法。BNP浓度测定采用美国Boisite公司Triage干式快速定量诊断仪采集静脉全血2mL加入EDTA抗凝试管摇匀取250μLEDTA抗凝全血加入检测板采用双抗夹心免疫荧光测试条(Biosite公司)对血浆BNP定量测定15min即可测出结果。NYHA心功能分级、超声心动图检查、漂浮导管检查、BNP检测采用盲法。1.3统计学处理实验数据以±s表示两组均数比较采用t检验多组均数的显着性检验用单因素方