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1、血浆脑钠肽浓度在急性肺栓塞治疗中的指导作用钟伟济冯起校于斌李志波(广东省中山市陈星海医院内科528415)【摘要】目的通过对急性肺栓塞治疗前后脑钠肽的分析对比,了解脑钠肽(BNP)水平与急性肺栓塞分型的相关性及对预后的评估。方法根据临床表现把32例急性肺栓塞(APE)患者分为3组:大面积型(A组,6例)、次大面积型(B组,21例)及非大面积型(C组,5例),其中B组乂分为溶栓亚组(B1组,10例)及非溶栓亚组(B2组,口例),对A组、B1组均予溶栓治疗及其他常规治疗;对B2组、C组予常规治疗,所有病例监测
2、右心功能、血气分析、》二聚体(DD)、脑钠肽、血压及出院后随访。结果血浆BNP浓度:A组(768±354pg/ml),B组(575±436pg/ml),C组(68±42pg/ml)oA组死亡5例,B2组4例死亡,B2组其中1例死亡病例是在3个月的随访期中与肺栓塞相关死亡,B1组、C组无死亡;存活病例治疗后BNP比治疗前均明显降低(P<0.01)c结论血浆BNP浓度与APE各分型、疗效呈一定相关性,通过治疗前后BNP的浓度对比变化,对APE的预后也可作出评估,
3、因此,检测血浆脑钠肽浓度在急性肺栓塞治疗中有着重要的指导作用。【关键词】脑钠肽急性肺栓塞分型预后相关性【中图分类号】R563.5【文献标识码】A【文章编号】2095-1752(2012)29-0128-02TheguidingroleofplasmabrainnatriureticpeptideIntreatmentofacutepulmonaryembolismZhongWeiji,FengQixiao’YuBin丄iZhibo(Departmentofinternalmedicin巳ChenXingh
4、aiHospitalofZhongshan,Guangdong,China,528415)[Abstract]ObjectiveToanalyzethelevelofbrainnatriureticpeptide(BNP)intreatmentofacutepulmonaryembolism(APE),GrasptherelationshipbetweenthelevelofBNPandtypingofAPEevaluatetheprognosis.Method:Atotalof32patientswit
5、hconfirmedAPEweredividedintothreegroups,accordingtotheclinicalmanifestations:massivepulmonaryembolism(groupA,n=6),submassivepulmonaryembolism(groupB’n二21),non-massivepulmonaryembolism(groupC,n=5),GroupBweredividedintothrombolyticsubgroup(groupBl,n=10)andn
6、on-thrombolyticsubgroup(groupB2,n=11),groupAandgroupBlreceivedthrombolyticandconventionaltreatment,groupB2andgroupCreceivedconventionaltreatment’andmonitortherightventricularfunctionandarterialbloodgaswereanalysedandD-dimerandbrainnatriureticpeptideandblo
7、odpressureanddischargedfromhospitalfollow-up・Results:plasmaBNP:groupA(768±354pg/ml),groupB(575±436pg/ml),groupC(68±42pg/ml).5patientsdiedingroupA’and4patientsdiedingroupB2,NopatientsdiedingroupBlandC.plasmaBNPinsurvivalcasessignifican
8、tlyreducedaftertreatment(P<O.Ol).Conclusinos:TheconcentrationsofplasmaBNPisrelatedtotypingofAPEandeffectivenessevaluation,TocomparedthelevelchangeofBNPintreatmentofAPE,AndevaluatetheprognosisofAPE.thereforeJherei