N氨基末端脑钠肽前体联合APACHE Ⅱ评分对急性心力衰竭患者近期预后评估的意义

目的：应用N氨基末端脑钠肽前体和APACHEⅡ评分评估急性心力衰竭患者近期预后。方法：选取因急性心力衰竭入院的患者51例,分为存活组（24例）、死亡组（27例）,于治疗前及治疗后7d（死亡患者截止死亡前）进行APACHEⅡ评分、N氨基末端脑钠肽水平测定、床旁心脏超声检测左心室射血分数（LVEF）。观察两组患者治疗前后APACHEⅡ评分、N末端脑钠肽及左心室射血分数（LVEF）指标的变化情况。结果：两组治疗前N氨基末端脑钠肽不存在明显差异（P〉0.05）的情况下,但APACHEⅡ评分存在差异（P〈0.01）,可以预测病死率。治疗过程中死亡率与N氨基末端脑钠肽的下降率（下降30%为界限）以及APACHEⅡ评分相关。结论：APACHEⅡ评分联合N氨基末端脑钠肽指标与急性心力衰竭危重程度相关,可以在治疗前和治疗中判断急性心力衰竭患者病死率及预后。

The significance of N-terminal pro-B-type natriuretic peptide combined with APACHE II score in the evaluation of patients with acute heart failure

Objective： To evaluate the significance of N-terminal pro-B-type natriuretic peptide combined with APACHE II score in the evaluation of patients with acute heart failure. Method： 51 cases admitted to hospital due to acute heart failure were selected and divided into survival group（24 cases） ,death group（27 cases）. APACHE II score, N-terminal pro-B-type natriuretic peptide were conducted before and 7 days after treatment （before death for died patients） , ejection fraction in left ventricular（LVEF） was detected with ultrasound machine. The changes of their APACHE II score,N-terminal brain natriuretic peptide precursor and LVEF were observed after treatment. Result： It was possible to predict mortality upon the difference of APACHE II score （P〈0.01） ,when there was no significant difference of N-terminal pro-B-type natriuretic peptide （P〈0.05） before treatment. The declining rate of N-terminal pro-B-type natriuretic peptide （the limit is 30%） and APACHE II score were found related to mortality during treatment. Conclusion：APACHE II score and index of N-terminal pro-B-type natriuretic peptide were associated with severity of acute heart failure,and can be jointly used to predict mortality and prognosis of patients with acute heart failure before treatment and during therapy.