血浆脑钠肽测定在肺源性和心源性呼吸困难鉴别诊断中的应用

发布时间：2018-08-03 10:20

【摘要】：背景呼吸困难在急诊内科及呼吸内科、心内科内均为常见的症状之一，尤其在急诊科呼吸困难多为急性发作，快速发现其原因对症治疗对于提高患者生存率和减少患者痛苦是十分必要的。导致呼吸困难的原因有多种，分别为：呼吸系统疾病、循环系统疾病、中毒、神经精神性、血液系统疾病。有研究指出急诊内科医生遇到的急性呼吸困难患者原因多为肺源性及心源性。近年来心脏多普勒超声心动图结合患者病史、症状、体征成为为鉴别心力衰竭的主要手段，因为心肺功能通常相互影响，尤其在老年患者或先天性心肺功能有缺陷者，只靠患者病史及症状体征往往不能准确鉴别之。同时超声心动图（ultrasonic cardiogram UCG）检查有其局限性：检查仪器不易搬动，使用不方便。纵然有床边UCG但若患者不能保持安静状态检查结果又偏差。不能及时正确的明确导致呼吸困难的原因导致错失最佳治疗时机，增加患者痛苦的同时会增加患者的医疗费用。因此寻找一种快捷、易操作、特异性和准确性较高的指标来指导呼吸困难的鉴别是医务工作者的迫切而必须的任务，具有重要的理论和实践意义。脑钠肽（brain natriuretic peptide BNP）是肽类家族的一种，最早由日本学者在猪脑中发现，之后有研究指出脑钠肽主要在心室细胞中合成，在心房及大脑中亦有少量合成。脑钠肽（BNP）合成与心室、心房压力改变有关，最初关于脑钠肽（BNP）的研究主要集中于左心功能不全。近年来随着研究的深入及科学技术的进步有越来越多的学者致力于研究脑钠肽（BNP）在其他方面的应用。如：与右心功能不全的关系，在儿科疾病诊断中的应用等。目的明确血浆脑钠肽(BNP)水平对鉴别肺源性与心源性呼吸困难的临床诊断意义，探讨其向临床应用转化的可能性。方法采用回顾性分析的方法，分析我院因呼吸困难检查血浆脑钠肽的113名患者，肺源性呼吸困难和心源性呼吸困难及左心、右心功能不全时脑钠肽水平的变化。结果肺源性呼吸困难时血浆BNP水平为59.06±41.40pg/ml，心源性呼吸困难时血浆BNP水平为415.10±286.24pg/ml，两组间比较具有显著性差异，（P0.001）,右心功能不全时血浆BNP水平为317.08±272.40pg/ml，左心功能不全时血浆BNP水平为487.18±278.22pg/ml，，两组间比较差异也有统计学意义，（P0.001）。结论肺源性与心源性呼吸困难时BNP水平升高，且升高程度与导致呼吸困难的不同原因有关，结合其他临床资料，BNP水平有助于鉴别肺源性与心源性呼吸困难以及进一步鉴别左心与右心功能不全，对快速鉴别呼吸困难原因有一定价值，可以转化应用于临床作为鉴别诊断呼吸困难原因的一个指标。
[Abstract]:Background dyspnea is one of the common symptoms in emergency department and respiratory department, especially in emergency department. Rapid detection of the cause of symptomatic treatment is essential to improve survival and reduce pain. There are many causes of dyspnea, such as respiratory diseases, circulatory diseases, poisoning, neuropsychiatric and hematological diseases. Some studies have pointed out that the causes of acute dyspnea encountered by emergency physicians are pulmonary and cardiogenic. In recent years, cardiac Doppler echocardiography combined with patient history, symptoms and signs has become the main means of distinguishing heart failure, because cardiopulmonary function usually affects each other, especially in elderly patients or patients with congenital cardiopulmonary dysfunction. The patient's history and symptoms and signs can not be accurately distinguished. At the same time, echocardiography (ultrasonic cardiogram UCG) has its limitations: the instrument is not easy to move and is not convenient to use. Even if there are bedside UCG, but if the patient can not maintain a quiet state of examination results and deviation. Failure to correctly identify the causes of dyspnea in time leads to missed optimal treatment opportunities, which increases the patient's pain and health care costs. Therefore, it is an urgent and necessary task for medical workers to find a quick, easy to operate, specific and accurate index to guide the identification of dyspnea, which has important theoretical and practical significance. Brain natriuretic peptide (brain natriuretic peptide BNP) is a kind of peptide family, which was first found by Japanese scholars in pig brain. Later, it was pointed out that brain natriuretic peptide is mainly synthesized in ventricular cells and a small amount in atrium and brain. The synthesis of brain natriuretic peptide (BNP) is related to the changes of ventricular and atrial pressure. The initial study of brain natriuretic peptide (BNP) mainly focused on left ventricular dysfunction. In recent years, with the development of science and technology, more and more researchers have devoted themselves to the application of brain natriuretic peptide (BNP) in other fields. Such as: the relationship with right ventricular insufficiency and its application in the diagnosis of pediatric diseases. Objective to determine the clinical diagnostic significance of plasma brain natriuretic peptide (BNP) levels in differentiating pulmonary and cardiogenic dyspnea and to explore the possibility of its transformation into clinical application. Methods the changes of brain natriuretic peptide levels in 113 patients with pulmonary dyspnea cardiogenic dyspnea left heart and right ventricular dysfunction were analyzed retrospectively. Results Plasma BNP levels were 59.06 卤41.40pg / ml in patients with pulmonary dyspnea and 415.10 卤286.24pg / ml in patients with cardiogenic dyspnea. There was significant difference between the two groups (P0.001). The plasma BNP levels in patients with right ventricular dysfunction were 317.08 卤272.40pg / ml, and those with left ventricular insufficiency were 317.08 卤272.40pg / ml. The plasma BNP level was 487.18 卤278.22 PG / ml, and the difference between the two groups was statistically significant (P0. 001). Conclusion the level of BNP increases in patients with pulmonary and cardiac dyspnea, and the degree of elevation is related to the different causes of dyspnea. Combined with other clinical data, BNP level is helpful to distinguish pulmonary and cardiogenic dyspnea and to further differentiate left and right heart dysfunction, which has certain value for rapid identification of the causes of dyspnea. It can be applied to clinical diagnosis of dyspnea.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.8

【相似文献】