经皮球囊二尖瓣成形术患者血浆心钠素和血管加压素水平的改变  

PLASMA ATRIAL NATRIURETIC PEPTIDE AND VASOPRESSIN LEVELS FOLLOWING SUCCESSFUL PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY

作　　者：许顶立 翁昌鸿 任昊[1] 方忠耀 张荣华[1] 候玉清 贾满盈 刘伊丽 

机构地区：[1]中国人民解放军广州第一军医大学南方医院心内科

出　　处：《中国循环杂志》1994年第12期727-730,共4页Chinese Circulation Journal

摘　　要：选择１６例风湿性二尖瓣狭窄患者进行经皮球囊二尖瓣成形术。术后心功能改善Ⅰ～Ⅱ级。术前，左右心房血浆心钠素水平明显高于外周静脉。研究发现，心房心钠素分泌增加可分为两型：右房分泌为主型者（ｎ＝５）；左房分泌为主型者（ｎ＝１１）。前一型的左心房平均压和右心房平均压均明显高于后一型。两型的外周血浆心钠素水平均无显著差异。术后５ｍｉｎ、２０ｍｉｎ、１ｈ、２４ｈ等时点，左右心腔和外周血浆心钠素水平均较术前显著下降。１６例患者术后２０ｍｉｎ时的左心腔血浆心钠素水平的降低幅度与二尖瓣跨瓣压差降低幅度显著相关（ｒ＝０．５０２，Ｐ＜０．０５）。术后血管加压素水平也显著下降，术后２４ｈ下降达７７．９±２．９％。这提示，成功地经皮球囊二尖瓣成形术可使风湿性心脏病患者血浆心钠素和血管加压素水平显著下降。Sixteen patients with mitral stenosis underwent percutaneous transvenous mitral commissurotomy (PBMV).Plasma atrial natriuretic peptide(ANP)and vasopressin levels were determined by radioimmunoassay. Before PBMV, the secretion of ANP of the patients was divided into two types.Type Ⅰ was left atrial secretion dominant(n=11),and type Ⅱ right atrial secretion dominant(n=5).The mean left atrial pressure and right atrial pressure were higher in type Ⅱthan in typeⅠ.Plasma ANP levels decreased at 5 min.20 min,1 hr,and 24 hrs after PBMV. The decrease of left ventricular plasma ANP levels positively correlated to the decrease of mean mitral pressure gradient.Plasma vasopressin levels also decreased at 1 hr and 24 hrs after PBMV. PBMV resulted in an increase in mitral valve area, an immediate reduction in left atrial pressure and right atrial pressure,and improvement of heart function.The results indicate that the significant decrease of plasma ANP and vasopressin levels is associated with successful PBMV.

关 键 词：心钠素 血管加压素 球囊二尖瓣成形 二尖瓣狭窄 

分 类 号：R654.2[医药卫生—外科学]