OBJECTIVETo study the plasma content of B-type natriuretic peptide (BNP) in patients with severe burn during shock stage and probe its clinical significance.

METHODSForty-two patients aged 18-60 years, with total burn surface area 30% TBSA or full-thickness burn area > or = 10% TBSA, hospitalized within 4 hours after burn, were divided into A group (with total burn surface area 30%-50% TBSA or full-thickness burn area 10%-20% TBSA, n = 21), and B group (with total burn surface area > 50% TBSA or full-thickness burn area > 20% TBSA, n = 21). Twenty patients admitted during the same time for plastic surgery were enrolled as control group. The plasma levels of BNP, creatine kinase (CK), CK-MB, troponin I (TnI) of all patients were determined on admission. The levels of BNP, TnI and fluid resuscitation volume were examined at 8, 16, 24, 48 post burn hour (PBH) in A and B groups. Analysis of correlation between BNP and fluid resuscitation volume was performed.

RESULTSOn admission: BNP level in A group (68 +/- 19 ng/L) and B group (99 +/- 38 ng/L), respectively, was increased as compared with that in control group (17 +/- 7 ng/L, P < 0.01). TnI level in A group (2.13 +/- 0.67 microg/L) and B group (2.98 +/- 0.58 microg/L), respectively, was increased as compared with that in control group (0.12 +/- 0.03 microg/L, P < 0.01). There was no obvious difference in CK, CK-MB levels among A, B, and control groups (P > 0.05). BNP levels in A, B groups continuously rose during 8-48 PBH, and they were positively correlated with fluid resuscitation volume. TnI level peaked at 24 PBH, and decreased at 48 PBH.

CONCLUSIONSThe plasma level of BNP is sensitive to reflect changes in myocardial ischemia and hypoxia as a rise in level of TnI in shock stage of severe burn, and it was positively correlated with fluid resuscitation volume. BNP can be used to guide fluid resuscitation during shock stage.