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目的 :探讨B型利钠肽(B type natriuretic peptide,BNP)对感染性休克患者早期液体复苏容量负荷的预测价值,从而更好地找出反映容量负荷的相关标志物,辅助判断ICU感染性休克患者容量状态。方法:选取入住ICU感染性休克患者60例,给予早期目标导向治疗(early goal-directed therapy,EGDT),利用脉搏指示连续心输出量监测系统记录早期液体复苏前后胸腔内血容量指数(intrathoracic blood volume index,ITBVI)、全心舒张末容积指数(global end diastolic volume index,GEDVI)、血管外肺水指数(extravascular lung water index,EVLWI)等血流动力学指标,并监测相应时间点全血BNP含量,通过与相应血流动力学指标进行相关性分析探讨两者相关性。结果:经过EGDT后,所有患者ITBVI、GEDVI、BNP均有显著升高,EVLWI未见明显升高;60例患者液体复苏0、6 h,BNP含量与对应的ITBVI、GEDVI、EVLWI均无显著相关性。液体复苏前后ΔBNP(前后时间点BNP差值)与对应的ΔITBVI、ΔGEDVI(前后时间点ITBVI、GEDVI差值)存在相关性,与ΔEVLWI(前后时间点EVLWI差值)无相关性。结论:BNP含量对感染性休克患者早期液体复苏容量负荷的评估价值尚不确定。
OBJECTIVE: To investigate the predictive value of B type natriuretic peptide (BNP) in the early stage of fluid resuscitation capacity in septic shock patients so as to better identify the relevant markers reflecting capacity load and to help determine the septic shock in ICU Patient capacity status. Methods: Sixty patients admitted to ICU with septic shock were enrolled in the study. Early goal-directed therapy (EGDT) was given. The pulse-based continuous cardiac output monitoring system was used to record the intrathoracic blood volume before and after resuscitation index (ITBVI), global end diastolic volume index (GEDVI) and extravascular lung water index (EVLWI) were measured. The levels of BNP in whole blood at the corresponding time points , Through correlation analysis with the corresponding hemodynamic indicators to explore the correlation between the two. Results: After EGDT, the ITBVI, GEDVI and BNP in all patients were significantly increased, while the EVLWI did not increase obviously. There was no significant correlation between BNP and corresponding ITBVI, GEDVI and EVLWI in 60 patients after liquid resuscitation Sex. Before and after liquid resuscitation, there was a correlation between ΔBNP (before and after BNP difference) and corresponding ΔITBVI, ΔGEDVI (before and after time point ITBVI, GEDVI difference) and ΔEVLWI (before and after EVLWI difference). CONCLUSION: The value of BNP level in assessing early volumetric fluid resuscitation load in septic shock patients is uncertain.