NT-proBNP动态测定对急性呼吸窘迫综合征合并感染性休克患者预后评估的价值-论文.pdf

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1、中国当代医药2014年9月第21卷第27期论著·NT—proBNP动态测定对急性呼吸窘迫综合征合并感染性休克患者预后评估的价值尹祥湖南省湘潭市湘乡人民医院重症医学科，湖南湘潭411400【摘要】目的讨论血浆NT—proBNP的动态变化对ARDS合并感染性休克患者预后评估的价值。方法采用前瞻性观察研究，收集51名ARDS合并感染性休克患者的血浆NT—proBNP指标纳入研究。人选患者于人住重症监护室第0、1、3天测定血浆NT-proBNP水平。根据住院28d的死亡情况，将患者分为死亡组与生存组并比较两组的NT-proBNP水平。应用ROC曲线评价APAC

2、HEH评分、NT—proBNPO、NT—proBNP1、NT—proBNP3、ANT—proBNP1、ANT-proBNP3、ANT-proBNP3—1对ARDS合并感染性休克患者病死率的预测价值。根据截点值分组并进行Kaplan—Meier分析。采用线性回归分析ARDS合并感染性休克患者的死亡危险因素。结果ROC曲线分析显示．ANT—proBNP3是预测患者病死率的可靠指标。ANT—proBNP3增长百分比最佳截点值为30％，灵敏度为84．6％，特异度为89．4％，(P=0．000)。ANT-proBNP3增长百分比<3O％组较ANT—proBNP3

3、增长百分比≥30％组的累积生存率更高(X2=62．693，P=-0．000)。ANT—proBNP3增长百分比≥30％是独立死亡危险因素。结论血浆NT—proBNP动态测定可能成为ARDS合并感染性休克患者预后评估的更有效的手段。【关键词】氨基末端B型脑钠肽前体；动态测定；急性呼吸窘迫综合征；感染性休克；预后[中图分类号】R563．9【文献标识码】A[文章编号】1674—4721(2014)09(c)一0011—05ValueofprognosticevaluationofdynamicdeterminationofNT-proBNPforpatien

4、tswithacuterespiratorydistresssyndromecomplicatedwithsepticshockYINXiangDepartmentofIntensiveCareUnit，XiangxiangPeoplesHospitalofXiangtanCityinHunanProvince，Xiangtan411400，China[Abstract]ObjectiveToinvestigatethevalueofdynamicchangeofplasmicN-terminalpro-brainnatriureticpeptid(N

5、T-proBNP)inpatientswithacuterespiratorydistresssyndrome(ARDS)complicatedwithsepticshock．MethodsAprospectiveobservationalstudywasconductedandtheindicatorsof51patientswithARDScomplicatedwithsepticshockwereincludedinthestudy．NT-proBNPplasmalevelweretestedfortheselectedpatientstheze

6、roth，first，thirdintheICU．Patientsweredividedintothedeathgroupandthesurvivalgroupaccordingtothedeathof28daysinhospitalandtheNT-proBNPlevelinthetwogroupswascompared．ROCcurvewasappliedtoevaluatethepredictivevalueofANT-proBNP1，ANT-proBNP3，ANT-proBNP3-1，NT-proBNP0，NT-proBNP1，NT-proBN

7、P3andAPACHElIscoreforthefatalityrateinpatientswithARDSeomplicatedwithsepticshock．Patientsweredividedintogroupsaccordingtothecut-ofvalueandKaplan-Meieranalysiswasconducted．Deathriskfactorwasassessedbylinearregressionanalysisinpatients．ResultsROCcurveanalysisshowedthatANT-proBNP3w

8、asareliableindicatorofpredictingthefatalityrate