Chest:ARDS患者的BNP、醛固酮水平和液体管理

2017-07-14 MedSci MedSci原创

保守的液体管理增加了急性呼吸窘迫综合征患者呼吸机的脱机的天数,但却对总的死亡率并无影响。血浆B型钠尿肽(左室充盈的标志物)或者醛固酮(有效循环血量的标志物)可能有助于指导ARDS患者的液体管理,从而对患者的生存率产生影响。

保守的液体管理增加了急性呼吸窘迫综合征患者呼吸机的脱机的天数,但却对总的死亡率并无影响。血浆B型钠尿肽(左室充盈的标志物)或者醛固酮(有效循环血量的标志物)可能有助于指导ARDS患者的液体管理,从而对患者的生存率产生影响。

本研究对急性呼吸窘迫综合征患者的液体管理进行随机对照比较,使用回顾性分析对液体管理和导管治疗试验进行分析。在患者被纳入研究时采集血液标本,使用免疫测定法测定患者血清BNP及醛固酮水平。多变量分析对BNP或者醛固酮的血清浓度和液体管理策略对60天住院死亡率的影响进行分析。

625例患者被纳入研究,平均血浆BNP浓度为825pg/ml(四分位距,144-1574 pg/ml),平均血清醛固酮浓度为2.49 ng/dL(四分位距,1.1-4.3 ng/dL)。B型钠尿肽不能对总死亡率进行预测,与液体平衡无明显相关,也不能改变保守的或自由的液体管理对预后的影响。相反,在血清醛固酮浓度较低的患者中,保守的液体管理增加了呼吸机脱机天数(17.1±9.8 vs 12.5±10.3,p<001),并且死亡率也有所降低(19% vs 30%,p=0.03)。

所以我们可以得出结论,在急性呼吸窘迫综合征患者中,B型钠尿肽的水平并不能指导液体管理从而对预后产生影响,但是较低的初始醛固酮水平似乎可以指导保守的液体管理从而可能改善患者的死亡率。

原始出处:

Matthew W. Semler, et al. B-Type Natriuretic Peptide, Aldosterone, and Fluid Management in ARDS. Chest. 2016 Jul; 150(1): 102-111.Published online 2016 Mar 23. doi:  10.1016/j.chest.2016.03.017

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    2017-10-24 Smile2680
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    2017-11-24 drwjr
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    2017-07-16 huiwelcome
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    2017-07-16 cmsvly

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