二尖瓣病变围手术期血管紧张素Ⅱ的变化  

The perioperative changes of angiotensin Ⅱ in mitral valve diseases

作　　者：张鹏[1] 王敏生[1] 沈学东[1] 王春生[1] 

机构地区：[1]上海医科大学中山医院心外科,上海市心血管病研究所200032

出　　处：《上海医学》1999年第12期711-713,共3页Shanghai Medical Journal

摘　　要：目的　了解二尖瓣狭窄、二尖瓣关闭不全以及二尖瓣狭窄合并关闭不全患者围手术期血浆血管紧张素Ⅱ（ＡⅡ） 水平变化情况，以指导临床用药。方法　应用放射免疫法测定患者在行二尖瓣替换术前、术后即刻、术后次日、术后３ 日以及术后１０ 日的血浆ＡⅡ水平。结果　二尖瓣狭窄（９例）以及二尖瓣狭窄合并关闭不全（９ 例） 的患者，术前血浆ＡⅡ水平分别为（２６９ ．１ ±９７ ．３）ｐｇ／ｍｌ 和（２７８ ．５±１２５ ．４）ｐｇ／ｍｌ，与１０ 例正常对照ＡⅡ水平为（５８ ．７ ±１８．４）ｐｇ／ｍｌ 相比，差异有显著性（ Ｐ＜０ ．０５），至术后１０ 日则下降至（７４ ．８±３２．３）ｐｇ／ｍｌ 和（６９ ．５ ±４５ ．２）ｐｇ／ｍｌ，与正常对照相比Ｐ＞ ０ ．０５ ；而二尖瓣关闭不全患者（１０ 例） 术前血浆ＡⅡ水平为（４５ ．８ ±１４ ．９）ｐｇ／ｍｌ，与正常对照相比差异无显著性（Ｐ＞ ０ ．０５） ，但术后早期即明显上升，术后１０ 日为（２０５．２ ±６８ ．３）ｐｇ／ｍｌ（ Ｐ＜ ０．０５） 。结论　为改善二尖瓣病变异常的血液动力学状态，二尖瓣狭窄以及二尖瓣狭窄合并二尖瓣关闭不全的患者术前应用血管紧张素转换酶抑制剂（ＡＣＥＩ）、二尖瓣关闭不全的患者术后早期?Objective To study perioperative plasma Angiotensin Ⅱ(AⅡ) levels in patients with mitral stenosis, mitral incompetence, or both as guidelines to treatment. Methods Used radioimmunoassay for testing the plasma AⅡ levels in patients cured by valve replacement preoperatively, immediately postoperatively and the 1st, 3rd, 10th day after the operation, respectively.Results In cases of mitral stenosis ( n =9) or mitral stenosis with mitral incompetence ( n =9), the plasma AⅡ levels were significantly higher than those before the operation( P <0.05), but declined gradually to normal levels after the operation ( P >0.05); while in cases of mitral incompetence, the plasma AⅡ levels were normal preperatively, but increased significantly during the early postoperative period ( P <0.05).Conclusion To improve the hemodynamic status in mitral valve diseases, it is necessary to use ACEI preoperatively in case of mitral stenosis or mitral stenosis combined with mitral incompetene, and its better to use ACEI during the early postoperative period in case of mitral incompetence.(Shanghai Med J, 1999,22∶711 713)

关 键 词：二尖瓣病变 血管紧张素Ⅱ 二尖瓣替换术 

分 类 号：R654.2[医药卫生—外科学]