老年严重脓毒血症患者和急性心衰患者血浆BNP水平的比较

目的观察老年严重脓毒血症患者血浆BNP水平的改变并探讨其临床意义。方法观察对象分为三组:78例老年严重脓毒血症患者,45例急性心力衰竭患者和59例健康对照组,测定其血浆BNP浓度。对其中的22例严重脓毒血症患者和16例心力衰竭患者分别进行肺动脉导管监测以评价血流动力学状态。结果(1)老年严重脓毒血症组、老年心力衰竭组和健康对照组的血浆BNP水平依次为912±757pg/ml,1143±791pg/ml和64.15±46.08pg/ml。严重脓毒血症组和心力衰竭组的血浆BNP水平明显高于对照组,P<0.001。老年严重脓毒血症组和老年心力衰竭组两组之间BNP无统计学差异(P>0.05)。(2)对部分病例进一步血流动力学监测表明老年严重脓毒血症组和老年心力衰竭组血流动力学不同但两组间的血浆BNP水平比较无明显差异(P>0.05)。(3)严重脓毒血症患者的血浆BNP水平与PAOP、CI无相关性,r值分别为0.164和0.004,P>0.05。结论严重脓毒血症和急性心衰时血浆BNP水平均明显升高,和急性心衰不同的是两者的血流动力学状态不同,BNP升高水平与炎症本身及脓毒血症相关的心肌功能不全及年龄等因素均有关,BNP不能作为替代严重脓毒血症时的血流动力学指标。

Comparison of Plasma Brain Natriuretic Peptide (BNP)Level in Elderly Patients with Severe Sepsis and Acute Heart Failure

Objective To compare plasma BNP level in elderly patients with severe sepsis and acute heart failure. Methods 78 old patients with severe sepsis or septic shock, 45 patients with acute heart failure （AHF） and 59 healthy subjects （control） were included in this study. Plasma BNP level was measured. 22 patients with severe sepsis and 16 patients with AHF were monitored with a pulmonary artery catheter to evaluate hemodynamic status. Results （1）BNP level was 912 ± 757pg/ml in patients with sepsis, 1143 ± 791pg,/ml in patients with AHF and 64.15±46.08pg/ml in healthy subjects. BNP level was much higher in patients with sepsis or with AHF than that in healthy old people（ P 〈 0.001 ）, but there was no difference between the patients with sepsis and AHF （ P 〉 0.05）. （2）Despite clear hemodynamic difference between the patients with sepsis and AHF, there was no statistically different between the two groups in BNP level. （3）Plasma BNP level was not correlated with PAOP and CI in patients with severe sepsis（r= 0.164 and 0. 004, P 〉 0.05）. Conclusions In elderly patients with severe sepsis or septic shock and with HF, BNP level was highly elevated, despite significant hemodynamic difference was found in AHF and sepsis or septic shock patients. The elevations of BNP level was linked to inflammation itself, sepsis-associated myocardial dysftmction and other factors such as age. BNP could not replace hemodynamic index.