脑钠肽在急性次大面积肺栓塞中临床意义的研究
发布时间：2018-10-26 18:29
【摘要】：目的探讨血浆脑钠肽在急性次大面积肺栓塞患者中的临床意义,包括：其升高水平与右心功能受累程度,评价其与肺栓塞患者严重程度的相关性,患者风险评估及临床预后的相关性,进一步指导急性次大面积肺栓塞患者是否选择溶栓的积极治疗。 方法2009年10月至2013年6月间青岛大学医学院附属医院收治的急性次大面积肺栓塞患者48例。其中男性25例,女性23例,平均年龄(64.7±11.4)岁。确诊方法根据2001年5月中华医学会呼吸分会制定的《肺血栓栓塞症的诊断与治疗指南(草案)》中的诊断标准。1.脑钠肽与急性次大面积肺栓塞患者病情严重程度的相关性研究。根据患者发病时血浆脑钠肽测定值分为两个观察组：A组(BNP500pg/ml)及B组(BNP500pg/ml)。通过比较发病时脑钠肽水平及动脉血气分析结果、发病时血心肌酶值、发病D-二聚体值、发病时心电图、超声心动图检查结果,来评价脑钠肽与急性次大面积肺栓塞患者病情严重程度的关系。2.脑钠肽对急性次大面积肺栓塞治疗策略的临床意义。上述每组患者给予两种不同的治疗方案。比较两个不同治疗组间治疗前后临床指标、临床重点事件以及12个月内预后情况。 结果 1.A、B两组患者的症状和体征存在明显差异,该差异具有统计学意义(P0.05)。在A组患者中,呼吸困难发生率为82%,而在B组发生率为35.3%。严重呼吸困难提示患者处于严重低氧状态,提示患者病情凶险程度。通过两组患者心电图异常改变的分析,提示A组心电图异常较B组严重,该差异具统计学意义(P0.05)。通过对患者超声心动图检查发现,A组患者右心负荷程度较B组严重,该差异具统计学意义(P0.05)。 2.A组患者中,溶栓序贯抗凝治疗组在临床的指标改善和效果上均好于单纯抗凝组,单纯抗凝组患者12个月内死亡率和复发率均高于溶栓序贯抗凝组。B组患者的观察中发现,溶栓序贯抗凝组和单纯抗凝组之间比较,各项指标无明显统计学差异,在预后和死亡率的比较也无明显差别。 结论 1.脑钠肽对急性次大面积肺栓塞危险分层及预后评估具有重要的临床价值。 2.脑钠肽数值的高低与急性次大面积肺栓塞患者病情的凶险程度密切相关。 3.脑钠肽明显增高的急性次大面积肺栓塞患者如无溶栓的绝对禁忌证,溶栓并序贯抗凝治疗应为首选治疗方案。
[Abstract]:Objective to investigate the clinical significance of plasma brain natriuretic peptide (BNP) in patients with acute submassive pulmonary embolism (ASPE). The correlation between risk assessment and clinical prognosis may further guide the choice of thrombolytic therapy in patients with acute submassive pulmonary embolism. Methods from October 2009 to June 2013, 48 patients with acute submassive pulmonary embolism were treated in affiliated Hospital of Qingdao University Medical College. There were 25 males and 23 females with an average age of (64.7 卤11.4) years. Diagnostic methods according to the diagnostic criteria in the guidelines for the diagnosis and treatment of Pulmonary Thromboembolism (draft) formulated by the Chinese Medical Association Respiratory Society in May 2001. 1. Relationship between brain natriuretic peptide and severity of acute submassive pulmonary embolism. Patients were divided into two groups: group A (BNP500pg/ml) and group B (BNP500pg/ml). The levels of brain natriuretic peptide and the results of arterial blood gas analysis were compared. The results of myocardial enzyme, D-dimer, electrocardiogram and echocardiography were compared. To evaluate the relationship between brain natriuretic peptide and severity of acute submassive pulmonary embolism. 2. Clinical significance of brain natriuretic peptide in the treatment of acute submassive pulmonary embolism. Each group was given two different treatments. The clinical indexes, clinical key events and prognosis in 12 months were compared between the two different treatment groups before and after treatment. Results 1. There were significant differences in symptoms and signs between the two groups (P0.05). 2. The incidence of dyspnea was 82 in group A and 35.3in group B. Severe dyspnea indicates that the patient is in a severe hypoxic state and that the patient's condition is dangerous. Through the analysis of the abnormal changes of electrocardiogram in two groups, the results showed that the abnormal ECG in group A was more serious than that in group B, and the difference was statistically significant (P0.05). Echocardiographic examination showed that the right ventricular load in group A was more serious than that in group B, and the difference was statistically significant (P0.05). 2. In group A, the clinical index improvement and effect of thrombolytic sequential anticoagulant therapy group were better than that of pure anticoagulant group. The mortality and recurrence rate in 12 months in simple anticoagulant group were higher than those in thrombolytic sequential anticoagulant group. There was also no significant difference in prognosis and mortality. Conclusion 1. Brain natriuretic peptide (BNP) has important clinical value in risk stratification and prognosis evaluation of acute submassive pulmonary embolism. 2. The level of brain natriuretic peptide is closely related to the severity of acute submassive pulmonary embolism. 3. If there is no absolute contraindication of thrombolytic therapy in patients with acute submassive pulmonary embolism, thrombolysis combined with sequential anticoagulant therapy should be the first choice.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R563.5
本文编号：2296596
[Abstract]:Objective to investigate the clinical significance of plasma brain natriuretic peptide (BNP) in patients with acute submassive pulmonary embolism (ASPE). The correlation between risk assessment and clinical prognosis may further guide the choice of thrombolytic therapy in patients with acute submassive pulmonary embolism. Methods from October 2009 to June 2013, 48 patients with acute submassive pulmonary embolism were treated in affiliated Hospital of Qingdao University Medical College. There were 25 males and 23 females with an average age of (64.7 卤11.4) years. Diagnostic methods according to the diagnostic criteria in the guidelines for the diagnosis and treatment of Pulmonary Thromboembolism (draft) formulated by the Chinese Medical Association Respiratory Society in May 2001. 1. Relationship between brain natriuretic peptide and severity of acute submassive pulmonary embolism. Patients were divided into two groups: group A (BNP500pg/ml) and group B (BNP500pg/ml). The levels of brain natriuretic peptide and the results of arterial blood gas analysis were compared. The results of myocardial enzyme, D-dimer, electrocardiogram and echocardiography were compared. To evaluate the relationship between brain natriuretic peptide and severity of acute submassive pulmonary embolism. 2. Clinical significance of brain natriuretic peptide in the treatment of acute submassive pulmonary embolism. Each group was given two different treatments. The clinical indexes, clinical key events and prognosis in 12 months were compared between the two different treatment groups before and after treatment. Results 1. There were significant differences in symptoms and signs between the two groups (P0.05). 2. The incidence of dyspnea was 82 in group A and 35.3in group B. Severe dyspnea indicates that the patient is in a severe hypoxic state and that the patient's condition is dangerous. Through the analysis of the abnormal changes of electrocardiogram in two groups, the results showed that the abnormal ECG in group A was more serious than that in group B, and the difference was statistically significant (P0.05). Echocardiographic examination showed that the right ventricular load in group A was more serious than that in group B, and the difference was statistically significant (P0.05). 2. In group A, the clinical index improvement and effect of thrombolytic sequential anticoagulant therapy group were better than that of pure anticoagulant group. The mortality and recurrence rate in 12 months in simple anticoagulant group were higher than those in thrombolytic sequential anticoagulant group. There was also no significant difference in prognosis and mortality. Conclusion 1. Brain natriuretic peptide (BNP) has important clinical value in risk stratification and prognosis evaluation of acute submassive pulmonary embolism. 2. The level of brain natriuretic peptide is closely related to the severity of acute submassive pulmonary embolism. 3. If there is no absolute contraindication of thrombolytic therapy in patients with acute submassive pulmonary embolism, thrombolysis combined with sequential anticoagulant therapy should be the first choice.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R563.5
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