张艳,赵昕,王效增,邓捷,王丽,任丽丽,顾崇怀,彭俊银,韩雅玲

• 1:沈阳军区总医院心血管内科
• 2:辽宁医学院

摘要(Abstract)：

目的旨在通过监测血清N末端B型脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)水平变化指导选择主动脉内球囊反搏(intra aortic balloon pump,IABP)停用时机。方法回顾性分析2013年1月至2014年7月在沈阳军区总医院行IABP辅助心功能的患者173例,以停用IABP后48 h内患者是否发生不良事件(包括二次使用IABP、肺水肿、血流动力学不稳定需要增加正性肌力药物、紧急气管插管、恶性心律失常及心原性死亡)分为成功组(127例)和失败组(46例),记录并分析置入IABP前和停用IABP前每位患者的NT-proBNP水平变化及随访期间主要不良心脏事件(MACE,包括再发心肌梗死、心力衰竭再入院及心原性死亡)的发生情况。结果两组患者置入IABP前NT-proBNP水平(P=0.151)及其他临床特征比较,差异均无统计学意义(P>0.05)。成功组患者NT-proBNP水平停用IABP前较置入IABP前显著降低(P<0.001),而失败组患者则显著升高(P<0.001)。ROC曲线显示,当NT-proBNP水平停用IABP前升高到较置入IABP前增加47.56%时预测停用IABP失败的灵敏度和特异度最大。成功组患者MACE发生率显著低于失败组(34%比81%,P<0.001)。结论血清NT-proBNP水平降低对停用IABP具有临床指导意义,但血清NT-proBNP水平升高达47.56%,提示需要考虑更多的治疗措施。

关键词(KeyWords)： N末端B型脑钠肽前体;主动脉内球囊反搏术;停用IABP

Abstract:

Keywords:

基金项目(Foundation): 中国医师协会探索心血管研究基金项目(DFCMDA201417)

作者(Author): 张艳,赵昕,王效增,邓捷,王丽,任丽丽,顾崇怀,彭俊银,韩雅玲

参考文献(References)：

• [1]Duaerman HL,Goldberg RJ,Gore JM.Treatment options for acute myocardial infarction com plicated by cardiogenic shock.Cardiol Rev,2000,8:207-215.
• [2]Barron HV,Every NR,Parsons LS,et al.The use of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction 2.Am Heart J,2001,141:933-939.
• [3]Januzzi JL Jr,Camargo CA,Anwaruddin S,et al.The NTerminal Pro-BNP Investigation of Dyspnea in the Emergency Department(PRIDE)study.Am J Cardiol,2005,95:948-954.
• [4]Clerico A,Fontana M,Zyw L,et al.Comparison of the diagnostic accuracy of brain natriuretic peptide(BNP)and the N-terminal part of the propeptide of BNP immunoassays in chronic and acute heart failure:a systematic review.Clin Chem,2007,53:813-822.
• [5]Doust JA,Pietrzak E,Dobson A,et al.How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure:systematic review.BMJ,2005,330:625.
• [6]Knebel F,Schimke I,Pliet K,et al.NT-pro BNP in acute heart failure:correlation with invasively measured hemodynamic parameters during recompensation.J Card Fail,2005,11(5Suppl):S38-S41.
• [7]Savarese G,Musella F,D'Amore C,et al.Changes of natriuretic peptides predict hospital admissions in patients with chronic heart failure:a meta-analysis.JACC Heart Fail,2014,2:148-158.
• [8]KrzychJ,Szurlej D,Koodziej T,et al.Diagnostic accuracy of pre-operative NT-pro BNP level in predicting short?term outcomes in coronary surgery:a pilot study.Kardiol Pol,2011,69:1121-1127.
• [9]Dehmer GJ,Blankenship JC,Cilingiroglu M,et al.SCAI/ACC/AHA Expert Consensus Document:2014 Update on Percutaneous Coronary Intervention Without On-Site Surgical Backup.Catheter Cardiovasc Interv,2014,84:169-187.
• [10]王守力,韩雅玲,荆全民,等床旁主动脉内球囊反搏术在急性冠脉综合征并发心源性休克救治中的应用.第四军医大学学报,2005,26:831-833.
• [11]Santa-Cruz RA,Cohen MG,Ohman EM.Aortic counterpulsation:a review of the hemodynamic effects and indications for use.Catheter Cardiovasc Interv,2006,67:68-77.
• [12]Papaioannou TG,Stefanadis C.Basic principles of the intra-aortic balloon pump and mechanisms affecting its performance.ASAIO J,2005,51:296-300.
• [13]吴铿,游琼,郑锡锋,等.经肱动脉与经股动脉路径进行主动脉内球囊反搏术治疗急性心肌梗死合并心源性休克患者的对比研究.中国介入心脏病学杂志,2014,22:106-110.
• [14]Nozohoor S,Nilsson J,Algotsson L,et al.Postoperative increase in B-type natriuretic peptide levels predicts adverse out come after cardiac surgery.J Cardiothorac Vasc Anesth,2011,25:469-475.
• [15]Mueller T,Gegenhuber A,Poelz W,et al.Diagnostic accuracy of B type natriuret ic peptide and amino terminal pro BNP in the emergency diagnosis of heart failure.Heart,2005,91:606-612.
• [16]Ma G,Liao W,Qiu J,et al.N-terminal prohormone B-type natriuretic pepti de and weaning outcome in postoperative patients with pulmonary complications.J Int Med Res,2013,41:1612-1621.
• [17]Tokita Y,Yamamoto T,Sato N,et al.Usefulness of N-Terminal Pro-Brain Natriuretic Peptide Levels to Predict Success of Weaning from Intra-Aortic Balloon Pumping.Am J Cardiol,2014,114:942-945.
• [18]Hsin HT,Chen LY,Lin PC,et al.Central venous oxygen saturation(Sc VO2)facilitates the weaning of intra-aortic balloon pump in acute heart failure related to acute myocard ial infarction.Int J Cardiol,2013,168:4568-4570.
• [19]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014.中华心血管病杂,2014,42:98-122.