天津医药

• 论著 • 上一篇    下一篇

B型钠尿肽对次大面积肺血栓栓塞症危险分层、治疗及预后评估的临床意义

谷松涛1,吴琦2   

  1. 1. 天津市胸科医院
    2. 天津市海河医院
  • 收稿日期:2010-12-22 修回日期:2011-07-18 出版日期:2012-02-15 发布日期:2012-02-15
  • 通讯作者: 吴琦

Clinical Significance of BNP for risk stratification,treatment and prognosis in submassive PTE

,   

  • Received:2010-12-22 Revised:2011-07-18 Published:2012-02-15 Online:2012-02-15

PDF (PC)

2082

摘要： 目的 探讨B型钠尿肽（BNP）在次大面积肺栓塞的危险分层、治疗方案选择及预后评估的临床意义。 方法 根据血浆BNP水平将84例次大面积肺栓塞患者分为两组：A组（n=50），BNP>90pg/ml和B组（n=34），BNP≤90pg/ml。其中A、B组内根据患者接受的治疗方法的不同，各自再分为溶栓并抗凝组和单纯抗凝组。分析BNP和患者临床特征、心电图表现、动脉血气体分析、超声心动图的关系，以及与次大面积肺栓塞患者危险分层、治疗方案选择及临床预后的关系。 结果 A组与B组在呼吸困难、胸痛、心率、呼吸频率、紫绀、心包和（或）胸腔积液、S2亢进、心肌酶异常、动脉血PaO2、A-aDO2、氧合指数、心电图严重度、右室和（或）右房扩大、PASP、中度（或重度）三尖瓣反流的比较均具有统计学差异（P<0.05）；A组与B组在治疗后12个月内出现临床重点事件：PTE复发、合并肺动脉高压或肺心病的比较具有统计学差异（P<0.05）；A组内溶栓加抗凝治疗组与单纯抗凝治疗组在△PASP、疗效、合并肺动脉高压、肺心病的比较均具有统计学差异（P<0.05）；B组内溶栓加抗凝治疗组与单纯抗凝治疗组在临床指标及治疗后12个月内出现临床重点事件的比较均无明显统计学差异（P<0.05）。 结论 BNP的检测有利于对次大面积肺栓塞患者进行高危筛查和预后评估，对治疗方案的选择具有重要的临床价值。

关键词: BNP, 次大面积肺栓塞, 危险分层, 治疗, 预后

Abstract: Objective To explore the clinical significance of BNP for risk stratification,treatment and prognosis in submassiv PTE.Methods A total of 84 patients with confirmed submassiv PTE were divided into two groups according to serum BNP levels,including Group A(n=50),BNP>90pg/ml and Group B(n=34),BNP≤90pg/ml.Meanwhile,the patients in Group A and Group B were respectively divided into two groups according the treatment:thrombolysis combined with anticoagulant therapy or simple anticoagulant therapy.The clinical feature,ECG,ABG,echocardiography and prognosis were analyzed and compared. Results There were significant differences in dyspnea,chest pain,heart rate,respiratory frenquency,cyanosis,pericardial or pleural effusion,accentuated S2,abnormal myocardial enzyme，arterial blood PaO2,A-aDO2，oxygenation index,severity of ECG,RAE or RVE,PASP,mid to deep degree of tricuspid regurgitation between Group A and B (P<0.05).There were significant differences in clinical key events:PTE recurrence,pulmonary artery hypertension,pneumocardial disease between Group A and B(P<0.05).There were significant differences in △PASP,therapeutic effect,pulmonary artery hypertension,pneumocardial disease between two sub-groups according to the treatment:thrombolysis combined with anticoagulant therapy or simple anticoagulant therapy of Group A.There were no significant differences between two sub-groups of Group B. Conclusion Serum BNP level is significant for submassive PTE patients to stratify the risk,select the fittest treatment and test the prognosis.

Key words: BNP, submassive PTE, risk stratification, treatment, prognosis