153例呼吸困難患者血漿腦利鈉肽水平的研究.doc

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1、153例呼吸困難患者血漿腦利鈉肽水平的研究【摘要】目的探討呼吸困難患者的血漿腦利鈉肽(BNP)水平與呼吸困難病因之間的相關性及臨床意義。方法　153例呼吸困難的患者分為三組：A組肺源性呼吸困難組51例；B組術后循環(huán)血量過多引發(fā)呼吸困難組46例；C組心肌收縮力障礙引發(fā)呼吸困難組56例，檢測其血漿BNP水平和超聲心動圖檢查左室射血分數(shù)(LVEF)，部分患者行漂浮導管監(jiān)測血流動力學。結果　153例呼吸困難患者的血漿BNP水平和左室射血分數(shù)(LVEF)分別是:A組為（178.25±45.43）pg/L、（0.61±0.07）pg/

2、L；B組為（3545.58±1147.48）pg/L、（0.59±0.06）pg/L；C組為（10471.55±3599.23）pg/L、（0.32±0.11）pg/L。C組病人的血漿BNP濃度顯著高于B及A組；而B組與A組EF值無明顯差別，血漿BNP濃度A組較B組顯著增高。結論　BNP的釋放直接與心室容量負荷過度和心室收縮力障礙相關，心室收縮力障礙似乎更能夠引起血漿BNP水平升高?！娟P鍵詞】心力衰竭；呼吸困難；循環(huán)血量；腦利鈉肽；血流動力學　　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