经导管封堵房间隔缺损对心脏结构及血中利钠肽水平的影响  

Changes of the constitutional and the plasma concentrations of cardiac natriuretic peptide after transcatheter closure of atrial septal defect

作　　者：陈刚[1] 吴继雄[1] 徐岩[1] 程自平[1] 王爱玲[1] 朱润硕[1] 史学功[1] 

机构地区：[1]安徽医科大学第一附属医院心内科,安徽合肥230022

出　　处：《心血管康复医学杂志》2009年第6期588-591,共4页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:观察用国产Amplatzer封堵器治疗继发孔型房间隔缺损(ASD)前后心脏结构及血浆心钠肽(ANP)、脑钠肽(BNP)的变化,探讨经导管ASD封堵术的影响。方法:应用超声心动图测量36例ASD患者封堵治疗前、治疗后1d、1月、3月、6月心脏结构参数,并分别测定相应时段血浆心钠肽、脑钠肽的浓度,另选取年龄及性别与之相匹配的健康人36例作为对照组。结果:同术前相比,术后1d、1月、3月、6月,右房、右室内径明显缩小(P<0.05),而左室舒张末期内径在术后1月、3月明显增大(P<0.05),左室收缩末期内径、左房内径及左室射血分数在术前及术后没有明显变化。ASD组ANP、BNP水平在封堵前较对照组明显升高,在封堵1d后开始显著逐渐下降,到6月后基本恢复至正常水平(P均<0.05)。结论:经导管ASD封堵术减轻了右心的容量负荷,使右房、右室内径明显缩小,也可在短期内改善左室的几何构型,血浆ANP、BNP水平可以作为评价经导管ASD封堵术对心脏容量负荷影响的一项有效指标。Objective： To detect the change of the cardiac construction and the levels of plasma atrial natriuretic peptide （ANP）, brain natriuretic peptide （BNP） after transcatheter closure of secundum atrial septal defect （ASD） with Amplatzer septal oecluder device, to explore the influence of the closure to them. Methods; Plasma ANP and BNP concentrations and transthoracic echocardiography （TTE） measurements of cardiac construction were performed in 36 patients with ASD before closure, and at One day, One month, three months and six months after closure. The 36 healthy subjects matched with ASD patients for age, sex were served as control subjects. Results： On the first day, first, third, sixth month after transcatheter closure the right atrium diameter （RAD）, right ventricular diameter （RVD） decreased significantly （P〈0. 05）, left ventricular end diastolic diameter （LVEDV） reduced significantly （P 〈0.05） on first month, third month after transcatheter closure; left ventricular end systolic diameter （LVEDV）, left atrium diameter （LAD）, left ventricular ejection fraction （LVEF） were not change significantly. Plasma ANP and BNP concentrations were higher significantly than those of control subjects before closure, declined after closure on first day, the Plasma ANP and BNP concentrations were stable on normal level roughly in six-month. Conclusion： The volume overload of the right heart is alleviated after transcatheter closure of ASD. The level of plasma ANP and BNP is an effective index for evaluate the influence of closure to the volume overload of the heart.

关 键 词：房间隔缺损 心钠素 利钠肽 脑 超声心动描记术 

分 类 号：R654.2[医药卫生—外科学]