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中心静脉压与BNP在糖尿病酸中毒合并心衰治疗中的意义(1)
http://www.100md.com 2012年10月15日 陈志
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     【摘要】 目的:分析中心静脉压(CVP)与B型脑钠肽(BNP)在糖尿病酸中毒中的变化及相关性,为临床合理补液提供依据。方法:回顾分析132例糖尿病酮症酸中毒患者的病历资料,依据是否合并心衰分为:心衰组73例和非心衰组59例;采用酶联免疫吸附法(ELISA)测定患者血浆BNP,有创心电监护测量CVP。结果:心衰组CVP及BNP较非心衰组明显增高,差异有统计学意义(P<0.01),不同心功能分级CVP与BNP呈正相关(r=0.087、0.092、0.97)。结论:(1)CVP与BNP在糖尿病酮症酸中毒合并急性心衰中均增高;(2)CVP与BNP在糖尿病酮症酸中毒急性心衰中呈正相关性;(3)CVP与BNP的监测可作为临床补液的参考依据。

    【关键词】 糖尿病酮症酸中毒; 心力衰竭; 中心静脉压; B型脑钠肽

    The Significance of Central Venous Pressure and BNP in Diabetic Ketoacidosis with Heart Failure/CHEN Zhi.//Medical Innovation of China,2012,9(29):044—045

    【Abstract】 Objective:To analyze the change and correlation of central venous pressure (CVP) and B—type natriuretic peptide (BNP) in diabetic ketoacidosis with heart failure ,to provide a basis for clinical rehydration.Method:A retrospective analysis of 132 cases of diabetic ketoacidosis,who were divided into tow group: heart failure group (73 cases), non—heart failure group (59 cases) that based on the records,by enzyme—linked immunosorbent assay (ELISA) to determine plasma BNP,and measure CVP by invasive ECG. Result:CVP and BNP of heart failure group were obviously higher than non—heart failure group,the difference of tow group were Statistically significant(P<0.01).Statistical significant difference,CVP and cardiac function in different BNP was positively correlated (r=0.087,0.092,0.97).Conclusion:⑴CVP and BNP in acute heart failure in diabetic ketoacidosis were increased.⑵ CVP and BNP were positively correlated.⑶ Monitoring of CVP and BNP can be used as a reference for clinical infusion.

    【Key words】 Diabetic ketoacidosis; Heart failure; Central venous pressure; B—type natriuretic peptide

    First—author’s address:The People’s Hospital of Xiangxi,Xiangxi 416000,China

    doi:10.3969/j.issn.1674—4985.2012.29.028

    DKA 是内科急危重症之一,以发病急、病情重、变化快为特点,在糖尿病中的发病率为14%。由于存在严重的内环境紊乱,极易造成脏器功能受损,临床上合并急性心衰病例常见。因此,如何掌控快速补液与急性心衰间的矛盾需要客观依据的支撑。本文拟通过分析糖尿病酸中毒合并心衰中CVP与BNP的变化及相关性为更为安全补液提供依据。

    1 资料与方法

    1.1 一般资料 所研究对象均来自本院2008年8月—2011年8月住院患者。心衰组73例,心功能按照美国NYHA标准分级,其中Ⅱ级37例,Ⅲ级25例,Ⅳ级11例;非心衰组59例,其年龄、性别与心衰组比较差异无统计学意义(P>0.05)。

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