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价值.docVIP

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价值 　　[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。入选患者于入住重症监护室第0、1、3天测定血浆NT-proBNP水平。根据住院28 d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APACHEⅡ评分、NT-proBNP0、NT-proBNP1、NT-proBNP3、ΔNT-proBNP1、ΔNT-proBNP3、ΔNT-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，ΔNT-proBNP3是预测患者病死率的可靠指标。ΔNT-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）。ΔNT-proBNP3增长百分比30%组较ΔNT-proBNP3增长百分比≥30%组的累积生存率更高（χ2=62.693，P=0.000）。ΔNT-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）-0011-05 　　Value of prognostic evaluation of dynamic determination of NT-proBNP for patients with acute respiratory distress syndrome complicated with septic shock 　　YIN Xiang 　　Department of Intensive Care Unit，Xiangxiang People′s Hospital of Xiangtan City in Hunan Province，Xiangtan 411400，China 　　[Abstract] Objective To investigate the value of dynamic change of plasmic N-terminal pro-brain natriuretic peptid （NT-proBNP） in patients with acute respiratory distress syndrome （ARDS） complicated with septic shock. Methods A prospective observational study was conducted and the indicators of 51 patients with ARDS complicated with septic shock were included in the study.NT-proBNP plasma level were tested for the selected patients the zeroth，first，third in the ICU.Patients were divided into the death group and the survival group according to the death of 28 days in hospital and the NT-proBNP level in the two groups was compared.ROC curve was applied to evaluate the predictive value of ΔNT-proBNP1，ΔNT-proBNP3，ΔNT-proBNP3-1，NT-proBNP0，NT-proBNP1，NT-proBNP3 and APACHEⅡ score for the fatality rate in patients with ARDS complicated with septic shock.Patients were divided into groups according to the cut-off value and Kaplan-Meier analysis was conducted.De