关键词: 休克, 脓毒性, 心钠素, 血流动力学, 预后

Abstract: Objective  To explore the prognostic value of plasma Btype natriuretic peptide (BNP) and  relationship with hemodynamic change in patients with septic shock. Methods  A retrospective study was conducted. Clinical data of 58 mechanically ventilated septic shock patients admitted in the Department of Critical Care Medicine in Subei People's Hospital from January 2015 to December 2016 were   analyzed．Cardiac index (CI)， stroke volume index (SVI) and globat end diastolic volume index(GEDI) were detected by pulse indicator continuous cardiac output (PiCCO) technology for 3 days.  Acute  Physiology and Chronic Health Evaluation Ⅱ（APACHEⅡ）  score， sequential organ failure assessment (SOFA) score， arterial blood lactate levels (Lac) and BNP were conducted after admission. According to the 28day mortality after admission in intensive care unit (ICU)， the patients were divided into survival group (n=36) and death group (n=22). The BNP， APACHEⅡ， SOFA and Lac in two groups were analyzed， and their relationships and outcome were analyzed. The receiver operating characteristic (ROC) curve was plotted to assess the value of BNP for predicting the outcome.  Results   Threeday BNP kinetics demonstrated a decline trend over time in survival group while no downtrend was found in death group， and there was significant difference in plasma BNP levels between  two groups. ROC curves demonstrated that the area under ROC curve (AUC) of BNP was 0.679（P=0.031）. As the cutoff point of BNP， the sensitivity and specificity of BNP predicting the survival of patients was 66.7% and 76.7%， respectively. Conclusion  Serum BNP could be a useful diagnostic indicator for septic shock. Prolonged BNP elevation and inability to reduce BNP after proper treat may imply increased mortality.

Key words: shock, septic； atrial , natriuretic factor; , hemodynamics; , prognosis