论文部分内容阅读
目的探讨快速检测氨基末端-脑钠肽前体(NT-proBNP)在急诊老年呼吸困难患者中的临床应用价值。方法根据病因将202例老年急性呼吸困难患者分为单纯肺源性呼吸困难组(A组);单纯心源性呼吸困难组(B组);混合性呼吸困难组(肺源性+心源性,C组)。床旁快速检测NT-proBNP水平,并行超声心动图检查,测量左心室射血分数(LVEF)。比较各组间NT-proBNP水平的差异及B,C两组中NT-proBNP水平与NYHA心功能分级和LVEF的相关性。结果 A组NT-proBNP水平明显低于B,C两组[(197.5±64.3)vs(1873.9±857.1)和(1952.4±914.8)ng/L,P<0.01]。B,C两组NT-proBNP水平差异无显著统计学意义(P>0.05),说明有心源性呼吸困难的患者NT-proBNP水平明显高于单纯肺源性呼吸困难患者。心功能Ⅱ级、Ⅲ级、Ⅳ级患者中,NT-proBNP水平依次升高,说明患者NT-proBNP水平越高,心功能分级越高[分别(562.37±102.45),(2736.72±81.67),(5873.19±127.73)ng/L,P<0.01]。Person直线相关分析发现,NT-proBNP水平与LVEF呈负相关(r=-0.689,P<0.01),提示NT-proBNP水平越高,LVEF值越低,心功能越差。结论 NT-proBNP水平检测在判断老年肺源性与心源性呼吸困难方面具有较好的临床鉴别诊断价值,其水平高低与心力衰竭严重程度密切相关。
Objective To investigate the clinical value of rapid detection of NT-proBNP in emergency elderly patients with dyspnea. Methods According to the cause, 202 elderly patients with acute dyspnea were divided into simple pulmonary-derived dyspnea group (group A), simple cardio-respiratory dysphagia group (group B), mixed dyspnea group (pulmonary + cardiogenic , Group C). The NT-proBNP level was measured at the bedside, and the left ventricular ejection fraction (LVEF) was measured by echocardiography. The differences of NT-proBNP levels between groups and the correlation between NT-proBNP levels and NYHA functional class and LVEF in group B and C were compared. Results The NT-proBNP level in group A was significantly lower than that in group B and C (197.5 ± 64.3 vs 1873.9 ± 857.1 vs 1952.4 ± 914.8 ng / L, P <0.01). There was no significant difference in NT-proBNP levels between groups B and C (P> 0.05), indicating that NT-proBNP levels in patients with cardiogenic dyspnea were significantly higher than those in patients with simple pulmonary dyspnea. The levels of NT-proBNP in patients with grade Ⅱ, Ⅲ and Ⅳ of heart function successively increased, indicating that the higher the level of NT-proBNP, the higher the grade of heart function [562.37 ± 102.45, 2736.72 ± 81.67, 5873.19 ± 127.73) ng / L, P <0.01]. Person linear correlation analysis found that NT-proBNP levels and LVEF was negatively correlated (r = -0.689, P <0.01), suggesting that the higher the NT-proBNP level, the lower the LVEF value, the poorer the heart function. Conclusion The detection of NT-proBNP has a good clinical value in differentiating senile pulmonary heart disease from cardiogenic dyspnea. The level of NT-proBNP is closely related to the severity of heart failure.