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目的探讨全血N末端脑钠肽前体(NT-proBNP)浓度与重度烧伤患者补液量的相关性;评价重度烧伤患者监测NT-proBNP的预警意义。方法选取2012年9月至2015年9月解放军第100医院烧伤科收治的重度烧伤患者53例,入院前均无重大疾病史、遗传史。其中烧伤面积在35%~50%总体表面积(TBSA)或者Ⅲ度10%~20%TBSA共25例为A组,烧伤总面积>50%TBSA或Ⅲ度>20%TBSA共18例为B组,烧伤总面积>90%且复合爆震伤患者共10例为C组;所有患者入院第1~30天监测NT-proBNP浓度用于指导输血及补液。对照组为53例同期年龄相仿的整形美容患者。与补液量计算公式相比,比较NT-proBNP的指导优势。结果此次纳入研究的烧伤患者实际补液量均高于通用补液公式计算出的结果,烧伤越严重,NTproBNP浓度越高,血制品需求量越多;C组与B组、B组与A组间进行比较,NT-proBNP浓度、补液量、MAP输注量、血小板输注量差异均有统计学意义(P<0.05)。结论 NT-proBNP浓度改变对重度烧伤患者中长期合理控制输血输液量可能有较高的指导和预警意义。
Objective To investigate the correlation between the concentration of NT-proBNP in whole blood and the amount of fluid rehydration in patients with severe burn and to evaluate the early warning of NT-proBNP in patients with severe burn. Methods Fifty-three patients with severe burn admitted to the 100th Hospital of PLA from September 2012 to September 2015 were selected. There was no major disease history or genetic history before admission. Twenty-five patients with burn area of 35% -50% TBSA or 10% -20% TBSA had a total burn area of 25 cases, Group B had a total burn area of> 50% TBSA or Grade III> 20% TBSA , Total burn area> 90%, and composite detonation injury in patients with a total of 10 cases in group C; all patients admitted to the hospital from the first 30 days to monitor the concentration of NT-proBNP used to guide blood transfusions and rehydration. The control group consisted of 53 plastic surgery patients of similar ages at the same period. Comparing the guidance advantages of NT-proBNP with the calculation of volume of fluid replacement. Results The actual volume of fluid in burns patients included in this study was higher than that calculated by the general rehydration formula. The more severe the burn, the higher the concentration of NTproBNP, the more the blood products. The patients in group C, B, B and A The differences of NT-proBNP concentration, fluid volume, MAP infusion volume and platelet transfusion volume were statistically significant (P <0.05). Conclusion The change of NT-proBNP concentration may have a higher guiding and warning significance on long-term and reasonable control of blood transfusion in severe burn patients.