【摘要】：目的探討血漿腦鈉肽在急性次大面積肺栓塞患者中的臨床意義,包括：其升高水平與右心功能受累程度,評價其與肺栓塞患者嚴重程度的相關(guān)性,患者風險評估及臨床預(yù)后的相關(guān)性,進一步指導(dǎo)急性次大面積肺栓塞患者是否選擇溶栓的積極治療。 方法2009年10月至2013年6月間青島大學醫(yī)學院附屬醫(yī)院收治的急性次大面積肺栓塞患者48例。其中男性25例,女性23例,平均年齡(64.7±11.4)歲。確診方法根據(jù)2001年5月中華醫(yī)學會呼吸分會制定的《肺血栓栓塞癥的診斷與治療指南(草案)》中的診斷標準。1.腦鈉肽與急性次大面積肺栓塞患者病情嚴重程度的相關(guān)性研究。根據(jù)患者發(fā)病時血漿腦鈉肽測定值分為兩個觀察組：A組(BNP500pg/ml)及B組(BNP500pg/ml)。通過比較發(fā)病時腦鈉肽水平及動脈血氣分析結(jié)果、發(fā)病時血心肌酶值、發(fā)病D-二聚體值、發(fā)病時心電圖、超聲心動圖檢查結(jié)果,來評價腦鈉肽與急性次大面積肺栓塞患者病情嚴重程度的關(guān)系。2.腦鈉肽對急性次大面積肺栓塞治療策略的臨床意義。上述每組患者給予兩種不同的治療方案。比較兩個不同治療組間治療前后臨床指標、臨床重點事件以及12個月內(nèi)預(yù)后情況。 結(jié)果 1.A、B兩組患者的癥狀和體征存在明顯差異,該差異具有統(tǒng)計學意義(P0.05)。在A組患者中,呼吸困難發(fā)生率為82%,而在B組發(fā)生率為35.3%。嚴重呼吸困難提示患者處于嚴重低氧狀態(tài),提示患者病情兇險程度。通過兩組患者心電圖異常改變的分析,提示A組心電圖異常較B組嚴重,該差異具統(tǒng)計學意義(P0.05)。通過對患者超聲心動圖檢查發(fā)現(xiàn),A組患者右心負荷程度較B組嚴重,該差異具統(tǒng)計學意義(P0.05)。 2.A組患者中,溶栓序貫抗凝治療組在臨床的指標改善和效果上均好于單純抗凝組,單純抗凝組患者12個月內(nèi)死亡率和復(fù)發(fā)率均高于溶栓序貫抗凝組。B組患者的觀察中發(fā)現(xiàn),溶栓序貫抗凝組和單純抗凝組之間比較,各項指標無明顯統(tǒng)計學差異,在預(yù)后和死亡率的比較也無明顯差別。 結(jié)論 1.腦鈉肽對急性次大面積肺栓塞危險分層及預(yù)后評估具有重要的臨床價值。 2.腦鈉肽數(shù)值的高低與急性次大面積肺栓塞患者病情的兇險程度密切相關(guān)。 3.腦鈉肽明顯增高的急性次大面積肺栓塞患者如無溶栓的絕對禁忌證,溶栓并序貫抗凝治療應(yīng)為首選治療方案。
[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 鹵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.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R563.5

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