标题：脓毒症患者严重程度与血流动力学指标和NT-proBNP的相关性

      作者：王会迟，李兰，王杨，方军，赵娟    (中国石油天然气集团公司中心医院重症医学科，河北 廊坊 065000)

      卷次： 2017年28卷9期

      【摘要】 目的 观察不同病情程度脓毒症患者血清N末端前体脑尿钠肽(NT-proBNP)和血流动力学指标的差异，并探讨血流动力学指标、NT-proBNP和脓毒症病情程度的相关性。方法 选取2013年1月至2016年6月中国石油天然气集团公司中心医院重症医学科首诊的 94例脓毒症患者，根据入院时病情程度分为脓毒症 33例(轻度组)、严重脓毒症31例(重度组)和脓毒症休克30例(休克组)，并根据患者30 d内死亡情况分为死亡组35例和生存组59例，比较不同病情、不同预后效果患者间血清NT-proBNP和血流动力学指标的差异，应用秩相关分析法对血清NT-proBNP、血流动力学指标与脓毒症病情程度间的相关性进行分析。结果 休克组患者的急性生理与慢性健康评分(APACHEⅡ)、序贯器官衰竭评估(SOFA)、30 d内死亡率、平均动脉压(MAP)、心指数(CI)、心率(HR)、二尖瓣舒张早期充盈峰速度E峰和舒张晚期充盈峰速度A峰比值(E/A)、左室射血分数(LVEF)、NT-proBNP异常程度重于其他各组，重度组上述指标异常程度重于轻度组，三组间上述指标比较，差异均具有统计学意义(P<0.05)；血清NT-proBNP、MAP、CI、HR与脓毒症病情程度评分有显著相关性 (P<0.01)；生存组和死亡组的年龄、血清NT-proBNP、MAP、CI、HR指标比较差异均有统计学意义(P<0.05)；COX生存分析结果显示年龄、血清NT-proBNP、HR与病死率呈显著相关(P<0.01)。结论 CI、HR和血清NT-proBNP及血流动力学指标是脓毒症疾病相关危险因素，其中年龄、血清NT-proBNP、HR、MAP是脓毒症独立危险因素，可作为危险评估和预后预测的可靠性指标。
      【关键词】 脓毒症；血流动力学指标；血清N末端前体脑尿钠肽；相关性
      【中图分类号】 R631 【文献标识码】 A 【文章编号】 1003—6350（2017）09—1390—05

Correlation of the disease severity and hemodynamic indexes, NT-proBNP in patients with sepsis.
WANG Hui-chi,LI Lan, WANG Yang, FANG Jun, ZHAO Juan. Department of Critical Care Medicine, Central Hospital of China Petroleumand Natural Gas Corporation, Langfang 065000, Hebei, CHINA
【Abstract】 Objective To observe the differences of N terminal pro-B-type natriuretic peptide (NT-proBNP)and hemodynamic indexes in patients with different severity of sepsis, and to discuss the correlation between hemody-namic indexes, NT-proBNP and the severity of sepsis. Methods A total of 94 patients with sepsis who were first diag-nosed in Department of Critical Care Medicine in Central Hospital of China Petroleum and Natural Gas Corporationfrom January 2013 to June 2016 were selected. According to the admission condition, they were divided into mild sepsisgroup (mild group, n=33), severe sepsis group (severe group, n=31) and septic shock group (shock group, n=30). Accord-ing to the death situation in 30 d, they were divided into the death group (n=35) and survival group (n=59). The differ-ence of serum NT-proBNP and hemodynamic index between different disease condition and different prognosis werecompared. The correlation between serum NT-proBNP, hemodynamic index and the severity of sepsis were analyzed byRank correlation analysis. Results The abnormality in Acute Physiology and Chronic Health Evaluation (APACHEⅡ), Sequential Organ Failure Assessment (SOFA), 30 d mortality, mean arterial pressure (MAP), cardiac index (CI),heart rate (HR), early diastolic mitral inflow peak velocity E and late diastolic filling peak velocity ratio (E/A), left ven-tricular ejection fraction (LVEF), NT-proBNP were more serious in shock group than in the other groups, and in severegroup than in the mild group. The differences among the three groups of above indicators were statistically significant(P<0.05). Serum NT-proBNP, MAP, CI, HR were significantly correlated with sepsis severity score (P<0.01). The differ-ences in age, serum NT-proBNP, MAP, CI, HR between the survival group and death group were statistically significant(P<0.05). COX survival analysis showed that age, serum NT-proBNP, HR and the mortality rate were significantly corre-lated (P<0.01). Conclusion CI, HR, and serum NT-proBNP and hemodynamic index are related risk factors of sepsisdisease. Among them, age, serum NT-proBNP, HR and MAP are the independent risk factors of sepsis, which can beused as reliable indexes for risk assessment and prognosis prediction.
      【Key words】 Sepsis; Hemodynamics indexes; N terminal pro-B-type natriuretic (NT-proBNP); Correlation·论 著·doi:10.3969/j.issn.1003-6350.2017.09.005基金项目：河北省廊坊市科技支撑计划（编号：2016013023）