【摘要】 目的:研究床边快速检测抗凝静脉全血N端脑利钠肽原(NT-proBNP)对急诊心源性呼吸困难和肺源性呼吸困难鉴别诊断的意义。方法:对我院急诊科就诊的158例呼吸困难患者分为心源性组82例,肺源性组76例,另选取58例正常人作为对照组。上述患者入院0.5h内完成床边急诊测定全血NT-proBNP浓度,48h内进行超声心动图检查。结果:①全血NT-proBNP浓度心源性组:(2026.4122.7)pg/ml,显著高于对照组(P<0.01);肺源性组:(191.828.12)pg/ml,与对照组无差异(P>0.05)。②心源性分组,充血性心衰(CHF)按NYHA分级,心功能Ⅱ级(n=15)、Ⅲ级(n=42)、Ⅳ级(n=25),全血NT-proBNP浓度均值分别为1513、2598、4357pg/ml,NT-proBNP的浓度与心衰的严重程度呈正比。③心功能Ⅱ级、Ⅲ级、Ⅳ级患者全血NT-proBNP水平与左心室射血分数(LVEF)的相关系数分别为r=-0.722(P<0.05)、r=-0.615(P<0.01)、r=-0.529(P<0.01),NT-proBNP水平与LVEF呈高度负相关。结论:呼吸困难急诊中,床边检测全血NT-proBNP浓度阴性的患者可快速排除心源性呼吸困难。心源性呼吸困难患者全血NT-proBNP浓度明显升高,结合超声心动图检查,提示全血NT-proBNP水平与心功能分级之间有明显的关联,心力衰竭程度越严重全血NT-proBNP越高,全血NT-proBNP测定可作为判断左心功能不全的参考性指标。更多还原

【Abstract】 Objective To study rapid bedside detection of NT-proBNP with anti-coagulated venous blood on the significance of differential diagnosis between cardiogenic dyspnea and palmonary dyspnea in emergency room.Methods 158 patients with dyspnea from our emergency department were divided into cardiogenic group 82 cases,pulmonary group 76 cases and 58 healthy persons as control.All patients within 30 min after hospitalized blood NT-proBNP were measured by rapid bedside technique.Also ultrasonic ECG were examined within 48hr.Results ①Blood NT-proBNP level of cardiogenic group(2026.4±122.7pg/ml): prominently higher than those in controls(P<0.01).Palmonary group(191±28.12pg/ml: no difference with controls(P>0.05).②Cardiogenic group: According to NYHA,grading and staging of CHF,cardias function grade Ⅱ(n=15),grade Ⅲ(n=42),grade Ⅳ(n=25).Mean level of blood NT-proBNP were 1513,2598,4537pg/ml individually.The concentration of blood NT-proBNP was correlated with severity of CHF.③Correlation coefficient of NT-proBNP levels on cardiac function grade Ⅱ,Ⅲ,Ⅳ and LVEF(left ventricular ejection fraction) were r=0.722(P<0.05),r=0.615(P<0.01) and r=0.529(P<0.01) respectively expressed higher negative correlation.Conclusion In the case of acute dyspnea,bedside NT-proBNP estimation can be ruled out patients from cardiogenic dyspnea rapidly.The more higher of plasma NT-proBNP combined with ultrasonic ECG indicates between the NT-proBNP level and grading or staging of cardiac function correlated apparently.The more severe of CHF,the more higher of blood NT-proBNP level simultaneously.Detection of blood NT-proBNP concentration may serve as predicator for left ventricles of heart insufficiency.更多还原