心肺复苏术中N—端脑利钠肽前体和肌钙蛋白的变化与意义(1)
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[摘要] 目的 探讨N—端脑利钠肽前体(NT—proBNP)和肌钙蛋白I(cTnI)在心肺复苏(CPR)术后的变化与意义。 方法 65例CPR术后患者按预后分为三组，A组：CPR 30 min，无效死亡，或自主循环建立(ROSC)<24 h；B组：复苏成功，ROSC≥24 h，但最终死亡出院；C组：复苏成功，存活出院。于0、3、6、12、24 h检测NT—proBNP和cTnI。 结果 在0 h，NT—proBNP、cTnI均无明显升高。B、C组6 h水平接近，B组在12、24 h显著升高，较C组升高(P < 0.05)；C组于6 h达峰值，24 h降至正常水平。 结论 NT—proBNP、cTnI能反映心肺复苏术后心肌损害的程度和心功能状况，如其持续升高，预后不良。
[关键词] 心搏骤停；心肺复苏；N—端脑利钠肽前体；肌钙蛋白I
[中图分类号] R459.7 [文献标识码] B [文章编号] 1673—9701(2012)27—0052—02
Change and clinical significance of NT—proBNP and cTnI in peripheral blood during cardiopulmonary resuscitation
LI Guoming
Department of Emergency， Central Hospital of Jiangmen in Guangdong Province， Jiangmen 529030， China
[Abstract] Objective To explore the relationship between the levels of NT—proBNP and cTnI and the prognosis of the patients received cardiopulmonary resuscitation (CPR). Methods Sixty—five patients received CPR were divided into three groups according to the prognosis. The patients who didn't regain recovery of spontaneous circulation were group A， those who had spontaneous circulation for over 24 hours but finally died were group B， and those who survived were group C. The levels of NT—proBNP and cTnI in peripheral blood were determined at the time of 0，3，6，12，24 h after CPR in all patients. Results The levels of NT—proBNP and cTnI had no significant difference at the beginning of CPR in all groups. No singificant difference was found before 6 h between group B and C. In group B， the NT—proBNP and cTnI significantly increased after successful CPR， and reached the highest level at 24 h. In group C， its peak was at 6 h， and then decreased nearly to the normal level after 24 h. Conclusion The levels of NT—proBNP and cTnI may indicate acute myocardium damage and heart failure in CPR. The massive expression of NT—proBNP and cTnI may be associated with high mortality for patients received CPR.
[Key words] Cardiac arrest； Cardiopulmonary resuscitation； NT—proBNP； cTnI
心肺复苏(cardiopulmonary resuscitation，CPR)术后出现复苏后综合征，心脏方面表现为心肌损伤及心功能不全。本试验对心肺复苏术后患者的N—端脑利钠肽前体(NT—proBNP)、肌钙蛋白I(cTnI)动态观察，研究其对心肺复苏术后患者预后的价值。
1 资料与方法
1.1 病例选择
收集2010年11月～2011年12月心搏骤停患者65例，男45例，女20例，平均年龄(55.72±15.15)岁。入选标准：突发心搏骤停，年龄>14周岁，进行CPR的患者。排除标准：慢性心力衰竭、脑疝、恶性肿瘤等处于疾病终末期、放弃抢救的心搏骤停者。
1.2 判断标准和抢救措施
心肺复苏标准依据《2010美国心血管急救及心肺复苏指南》[1]进行。心搏骤停一经诊断，立即进行抢救，包括基础生命支持、高级生命支持。
1.3 分组标准
依据预后分为三组，A组：CPR 30 min，死亡出院，或自主循环建立(ROSC)<24 h，共33例。B组：复苏成功，ROSC≥24 h，但最终死亡出院，共19例。C组：复苏成功，存活出院，共13例。
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