153例呼吸困难患者血浆脑利钠肽水平的研究.doc

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1、153例呼吸困难患者血浆脑利钠肽水平的研究【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/

2、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浓度显著高于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组显著增高。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:ObjectiveTodeterminethecorrela

3、tionbetweenthebloodlevelofBnatriureticpeptide(BNP)andhemodynamicalterations,andevaluatethediagnosticvalueofBNPinpatientswithdyspneaduetodifferentcauses.Methods　BNPlevelswereobtainedbyarapidimmunofluorescenceassayin153patientswithdyspnea,whichweredividedintothreeg

4、roups,firstgroupforlungdisease(51patients),secondforoverloadofcirculatorybloodvolume(46patients),andanotherforcardiogenicgroup(56patients).Hemodynamicparametersofallpatientsweredetermined,andleftventricularenddiastolicdiameters(LVEDD)weremeasuredwithechocardiogram

5、.Results　Pulmonarycapillarywedgepressure(PCWP,mmHg)was(8.20±2.60)inthefirstgroup,(11.50±3.72)inthesecondgroupand(30.43±7.61)inthelastgroup.Centralvenouspressure(CVP,mmHg)ofthreegroupswere(6.50±1.90),(20.95±4.11)and(15.27±4.96)respectively.BNP(pg/L)levelswere(178.2

6、5±45.43),(3545.58±1147.48),and(10471.55±3599.23)respectively,andleftventricularejectionfraction(LVEF)were(0.59±0.06),(0.61±0.07),and(0.32±0.11).BNPlevel(918148±453125)pg/LofthegroupwithLVEDD≥60mmwasmuchhigherthanthatofthegroupwithLVEDD<60mm(298158±167151)pg/L,w

7、hichwaslowestinpulmonarydiseasesgroupwithanormalleftandrightventricularenddiastolicdiameter(3514±2614)pg/L.TherewasagreatdifferenceofBNPbetweencardiogenicdyspneagroup(761130±480147)pg/Landpulmonarydiseasegroup(3514±2614)pg/L.Conclusions　Beingakindofcardiacneurohor

8、monesecretedfromcardiacventriclesasaresponsetoventricularvolumeexpansionandpressureoverload,BNPhada4significantincreasedlevelinpatientswithhighPCWP.　　Ke