中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

急性肺栓塞患者右心功能不全诊断指标的比较分析

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目的 比较血压、脑钠肽(BNP)、肺动脉收缩压(PASP)对急性肺栓塞(APE)患者右心功能不全(RVD)的诊断价值。 方法 回顾性分析 84 例经 CT 肺动脉造影确诊的 APE 病例。根据心脏超声分为有 RVD 组和无 RVD 组。以 18 个临床及辅助检查变量为研究因素,RVD 为相关因素,经 Logistic 回归模型评估 RVD 与以上研究因素的关系。通过受试者工作特征(ROC)曲线分析 BNP、PASP 对 RVD 的预测价值。 结果 有 RVD 组心率快于无 RVD 组,舒张压、平均动脉压高于无 RVD 组,BNP>100 pg/ml 者比率大于无 RVD 组,PASP>40 mm Hg 者比率大于无 RVD 组(均P<0 05="" logistic="" bnp="">100 pg/ml(OR=4.904,95%CI 1.431~16.806,P=0.011)和 PASP>40 mm Hg(OR=6.415,95%CI 1.509~27.261,P=0.012)与 RVD 相关。BNP 诊断 RVD 的 ROC 曲线下面积为 0.823(95%CI 0.729~0.917),PASP 诊断 RVD 的 ROC 曲线下面积为 0.798(95%CI 0.700~0.896)。 结论 血压相关参数不能作为 RVD 的预测指标。联合检测 APE 患者 BNP 及 PASP 有助于准确预测 RVD。

Objective To explore and compare the diagnostic value of blood pressure, brain natriuretic peptide (BNP), pulmonary artery systolic pressure (PASP) in evaluating right ventricular dysfunction (RVD) in patients with acute pulmonary embolism (APE). Methods A retrospective study was conducted on 84 APE patients who were diagnosed by computed tomographic pulmonary angiography. The patients were divided into a RVD group and a non-RVD group by echocardiography. Eighteen clinical and auxiliary examination variables were used as the research factors and RVD as the related factor. The relationship between these research factors and RVD were evaluated by logistic regression model, the diagnostic value of BNP and PASP to predict RVD was analyzed by receiver-operating characteristic (ROC) curve analysis. Results The patients with RVD had more rapid heart rate, higher diastolic blood pressure, higher mean arterial pressure, higher incidence of BNP>100 pg/ml and higher incidence of PASP>40 mm Hg (allP<0 05="" upon="" logistic="" regression="" model="" bnp="">100 pg/ml (OR=4.904, 95%CI 1.431–16.806, P=0.011) and PASP>40 mm Hg (OR=6.415, 95%CI 1.509–27.261, P=0.012) were independent predictors of RVD. The areas under the ROC curve to predict RVD were 0.823 (95%CI 0.729–0.917) for BNP, and 0.798 (95%CI 0.700–0.896) for PASP. Conclusions Blood pressure related parameters can not serve as a predictor of RVD. Combined monitoring of BNP level and PASP is helpful for accurate prediction of RVD in patients with APE.

关键词: 肺栓塞; 右心功能不全; 脑钠肽; 血压; 肺动脉收缩压

Key words: Pulmonary embolism; Right ventricular dysfunction; Brain natriuretic peptide; Blood pressure; Pulmonary artery systolic pressure

引用本文: 张艳敏, 张庆, 杨林瀛. 急性肺栓塞患者右心功能不全诊断指标的比较分析. 中国呼吸与危重监护杂志, 2018, 17(6): 577-581. doi: 10.7507/1671-6205.201806020 复制

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