重组人脑利钠肽对感染性休克患者心功能的动态影响

目的 通过单中心前瞻性随机对照研究观察重组人脑利钠肽(rhBNP)对感染性休克患者心功能及组织灌注的影响,并进行动态分析.方法 2014年1月至2016年2月,对广东省人民医院ICU病区共100例感染性休克患者进行前瞻性研究,全部病例参照6h早期目标导向治疗方案(EGDT),采用随机数字表法随机产生49例试验组患者(应用rhBNP),51例对照组患者(不使用rhBNP).主要观察指标为两组患者治疗72 h后的心脏指数(CI)和静脉血中氨基末端BNP前体(NT-proBNP)水平,次要观察指标为治疗72 h后患者的心率(HR)、平均动脉压(MAP)、经皮血氧饱和度(SPO2)及乳酸水平(Lac).同时记录试验组和对照组应用rhBNP后即刻、24 h、48 h及72 h的NT-proBNP、Lac及HR、CI、MAP、SPO2的变化,以明确应用rhBNP后的动态变化情况.最后比较两组患者ICU住院天数和28 d病死率.结果 治疗前两组患者基线资料差异无统计学意义.治疗72 h后,主要观察指标:试验组患者的Pro-BNP明显低于对照组[P=0.030;试验组和对照组Pro-BNP分别为(14 965.7 ±5 984.5) pg/mL、(17 392.5±3 830.5) pg/mL;试验组患者的CI有明显提高,P=0.002;试验组和对照组的CI分别为:(4.0±0.2)、(3.7±0.6)].次要观察指标:Lac有明显下降趋势[P=0.001;试验组和对照组Lac分别为(2.4±0.6)mmol/L、(3.7±0.6) mmol/L].试验组24h后HR明显下降[患者治疗前HR为(113.3±7.2)次/min,经rhBNP治疗24h后HR为(97.5±14.7)次/min],但与治疗24 h点比较,随后24 ～72 h HR无明显变化;MAP、SPO2在rhBNP治疗前后无明显改变.与对照组比较,试验组患者ICU住院时间明显缩短[(12.93±7.45) dvs.(20.67±6.96)d,P＜0.01),28 d病死率显著降低(30.6％(15/49) vs.54.9％ (28/51),P=0.014).结论 rhBNP治疗72 h后能明显降低感染性休克患者Pro-BNP及乳酸水平,提升心脏指数,提示其可改善感染性休克患者的心功能及组织灌注,最终缩短其ICU住院时间,降低28 d病死率.

Therapeutic effects of recombinant human brain natriuretic peptide on cardiac function in patients with septic shock

Objective To observe the change of cardiac function and tissue perfusion in septic shock patients treated with recombinant human brain natriuretic peptide (rhBNP) in a single center prospective randomized controlled study,and the therapeutic effects of it were analyzed.Methods A total of 100 patients with septic shock admitted in the ICU ward of Guangdong General Hospital were prospectively studied from January 2014 to February 2016.In reference to 6 h early goal-directed therapy (EGDT),49 patients of experimental group treated with rhBNP and 51 patients of control group without rhBNP treatment were randomly generated by means of random number table.The main parameters of outcome were defined in cardiac index (CI) and amino terminal pro-BNP precursor (NT-proBNP) level in venous blood in patients 72 hours after presence or absence of the treatment of rhBNP,and the secondary parameters of outcome were confined to the patient's heart rate (HR),mean arterial pressure (MAP),transcutaneous oxygen saturation (SPO2),lactic acid (LAC) in patients 72 hours after presence or absence of the treatment of rhBNP.At the same time,the changes in the levels of NT-proBNP,Lac and HR,CI,MAP,SPO2 at 0 h,24 h,48 h,and 72 hours after treatment with rhBNP in the experimental group and control group without rhBNP treatment were recorded in order to detect the therapeutic effects of rhBNP.Results There were no significant differences in demographics between the two groups.Compared with control group,the length of ICU stay time was shorter [(12.93 ±7.45) vs.(20.67 ±6.96),P ＜0.01] and the mortality rate was lower in the experimental group (30.6％,(15/49) vs.54.9％,(28/51),P =0.014).After treatment for 72 h,the level of Pro-BNP in experimental group was significantly lower than that in control group (14 965.7 ± 5 984.5) pg/mL vs.(17 392.5 ± 3 830.5) pg/mL,P=0.030);the CI in experimental group were significantly improved compared to control group [(4.0 ± 0.2) vs.(3.7 ± 0.6),P =0.002].the Lac were significantly decreased in experimental group compared to control group [(2.4 ± 0.6) mmol/L vs.(3.7 ± 0.6) mmol/ L,P =0.001].The HR in experimental group were significantly decreased after treatment for 24 h compared to HR before the treatment with rhBNP (the HR in patients before treatment of rhBNP was (113.3 ± 7.2) beats/min,the HR in patients with the treatment of rhBNP for 24 h was (97.5 ± 14.7) beats/min;but there was no significant further change in HR during 24 h-72 h;there were no significant changes in MAP and SPO2 in patients before and after the treatment of rhBNP.Conclusions The rhBNP can significantly reduce Pro-BNP and lactate levels and improve cardiac index in septic shock patients treated with rhBNP for 24 h,suggesting that rhBNP can improve cardiac function and tissue perfusion in septic shock patients.