氨基末端脑钠肽对风湿性瓣膜病患者围手术期风险性评估的意义  

Meaning of Perioperative Plasma Concentration of NT-ProBNP in the Risk Assessment of Rheumatic Valve Disease

作　　者：王彪[1] 王涛[1] 吴树明[1] 张供[1] 曹广庆[1] 杨洪阳[1] 

机构地区：[1]山东大学齐鲁医院心脏外科,山东省济南市250012

出　　处：《中国循环杂志》2008年第1期53-56,共4页Chinese Circulation Journal

摘　　要：目的:研究风湿性瓣膜病患者围手术期血清氨基末端脑钠肽(NT-proBNP)浓度值的变化及其意义。探讨监测围手术期间血清NT-proBNP浓度值对瓣膜置换术后早期风险性的评估作用。方法:2007-06至2007-10选择符合条件的41例在常规体外循环下行换瓣手术的风湿性瓣膜病患者。分别于术前,术后3 h,24 h,48 h,120 h抽取外周动脉血测定血清NT-proBNP值,分析围手术期其浓度变化。测定术前和术后16小时的心脏输出量(CO)和心脏指数(CI)值,比较术前血清NT-proBNP浓度值与CO和CI的关系。按照术后有无死亡,新发生心律失常,重要脏器功能受损,多巴胺使用时间,术后呼吸机辅助时间等,比较术前NT-proBNP浓度值。结果:①NT-proBNP浓度值术后3 h开始上升,术后24 h达到高峰,与术前比差异具有显著意义(P<0.01),此后缓慢下降,但是术后第120 h仍然高于术前,与术前比差异有统计学意义(P<0.01)。②术前NT-proBNP浓度值与术前CO值呈负相关r=-0.8734,t=-11.2022,P<0.0l;和术后16 h的CO值呈负相关r=-0.8579,t=-10.4291,P<0.01;术前NT-proBNP浓度值与术前CI值呈负相关r=-0.8481,t=-9.9969,P<0.01;和术后16 h的CI值呈负相关r= -0.7691,t=-7.5148,P<0.01。③心律失常,脑、肝、肾等重要脏器功能受损等并发症患者的术前血清NT-proBNP浓度值明显高于无并发症患者,差异有统计学意义(P均<0.01)。结论:术前监测血清NT-proBNP浓度值对于评估风湿性瓣膜病围手术期风险性具有重要意义。围手术期血清NT- proBNP浓度值越小,术后CO,CI较高,其术后并发症较少,术后恢复较好。术后早期NT-proBNP浓度开始升高,24 h达到高峰,后期开始下降。Objective： To investigate the perioperative changes of serum N-terminal pro-brain natriuretic peptide （NT-proBNP） concen-tration in patient with rheumatic valve disease undergoing cardiac valve repalcement and study the meaning of perioperative serum concentration of NT-proBNP in the perioperative risk assessment of rheumatic valve disease. Methods： There are 32 patients accord with conditions admitted to the study, the serum NT-proBNP conentration was measured before cardiac surgery, 3 h （hours）, 24 h, 48 h, and 120 h after surgery. The cardiac output （CO） ,cardiac index （CI）before and 16 h after sugery was measured by transesophageal echo-doppler, then compare their relationship between the NT-proBNP concentration. And clinical function state associated with operative death, arrhythmia, inotropic agents, ventilation time respectively. Results ： ①The postoperative NT-proBNP level had no remarkable change 2 hours after operation （P 〉 0.05 ）, but elevated markedly and acutely to a peak level at 24 h after operation （P 〈0. 01） ,then it reduced remarkable at 48 h and 120 h after operation but still higher than its orininal level before operation（P〈0.01）. ②NT-proBNP level before operation were significantly negatively correlated with CO before operation （r=-0.8734 ,t=-11.2022 ,P〈 0.01） and 16 h after operation（r=-0.8579, t=-10.4291 ,P 〈0.01）. It is also significantly negatively correlated with CI before operation （r = -0. 8481, t = -9. 9969, P 〈 0.01） and 16 h after operation （r=-0.7691, t=-7.5148, P〈0.01）. ③Compared with uneventful cases there ware higher preoperative serum NT-proBNP concentration in patients with postoperative morbility. Represented by long time intropics and ventilation support. Conclusion： The perioperative serum NT-proBNP level have a important clinical significance in assessment of perioperative risk in patients with rheumatic valve disease undergoing valvular replacement. Patients with lower preoperative serum NT-proBNP

关 键 词：脑钠肽 风湿性瓣膜病 

分 类 号：R541.2[医药卫生—心血管疾病]