奈西立肽在心脏瓣膜术后早期应用的临床价值  

Clinical value of early application of nesiritide after cardiac valve surgery

作　　者：曾娟[1] 于涛[2] 李健[1] 侯晓林[3] 刘蓉安[4] 曾庆华[1] 

机构地区：[1]四川省医学科学院.四川省人民医院全科医学中心,四川成都610027 [2]四川省医学科学院.四川省人民医院心脏外科,四川成都610027 [3]四川省医学科学院.四川省人民医院编辑部,四川成都6100273 [4]四川省医学科学院.四川省人民医院重症监护室,四川成都610027

出　　处：《中国生化药物杂志》2015年第9期57-60,共4页Chinese Journal of Biochemical Pharmaceutics

摘　　要：目的观察心脏瓣膜术后早期应用奈西立肽对心肌损伤及心功能的保护作用。方法连续收集2013年11月-2015年2月四川省人民医院心外科收治的心脏瓣膜病患者78例,随机分为奈西立肽组（n=38）和对照组（n=40）。奈西立肽组患者在术后常规心肌保护治疗的基础上给予24-72 h的奈西立肽[0.01μg/（kg·min）]治疗。对照组患者术后仅接受常规心肌保护治疗。观察指标：1心肌肌钙蛋白（c Tn I）、磷酸肌酸激酶同工酶（CK-MB）：分别在术前、术后0、24、72 h抽取静脉血检测;2患者血肌酐（SCr）：分别在术前、术后7 d抽取静脉血检测;3左室射血分数（LVEF）：分别在术前、术后7 d行超声心动图测定;4ICU停留时间及机械辅助通气时间。结果 2组患者术后24 h c Tn I及CK-MB差异无统计意义;奈西立肽组术后72 h c Tn I为（5.10±2.03）ng/m L,显著低于对照组的（8.94±3.35）ng/m L（P〈0.05）,奈西立肽组CK-MB为（36.27±12.18）U/L,显著低于对照组的（23.24±14.67）U/L（P〈0.05）;2组患者术后7 d的SCr水平差异无统计学意义;术后7 d奈西立肽组LVEF为（60.47±8.60）%,较对照组（54.60±10.92）%明显改善（P〈0.05）;2组患者ICU停留时间差异无统计学意义,但奈西立肽组机械辅助通气时间[（3.14±1.95）d]明显短于对照组[（4.29±2.25）d,P〈0.05]。结论心脏瓣膜术后早期应用奈西立肽可减轻心肌损伤,改善心脏功能。Objective To identify the protective effects of early application of nesiritide on myocardial injury and cardiac function after cardiac valve surgery. Metheds 78 patients with cardiac valve surgery in the hospital from November 2013 to February 2015 were randomly divided into nesiritide group（ n = 38） and control group（ n = 40）. Nesiritide group received the routine treatment plus 24-72 hour treatment of nesiritide [0. 01 ug /（ kg·min） ],and control group received only the routine treatment. Observation index： 1Cardiac troponin（ c Tn I） and MB isoenzyme of creatine kinase（ CK-MB） ： venous blood was tested before and after operation 0h,24 h and 72 h; 2Serum creatinine（ SCr） ： venous blood was tested before and after surgery 7 days; 3Left ventricular ejection fraction（ LVEF） ： echocardiography was done before and after operation 7 days; 4 ICU residence time and mechanical ventilation time. Results There was no significant difference between two groups in c Tn I and CK-MB at 24 hour after operation. However,at72 hour after operation,c Tn I in nesiritide group was（ 5. 10 ± 2. 03） ng / m L,lower than that in control group[（ 8. 94 ± 3. 35） ng / m L,P〈0. 05]; CK-MB in nesiritide group was（ 23. 24 ± 14. 67 U / L）,lower than that in control group[（ 36. 27 ± 12. 18） U / L,P〈0. 05]. There was no significant difference in SCr level between two groups after operation. At 7 day after operation,LVEF improved significantly in nesiritide group[（ 60. 47 ± 8. 60） %] comparing with control group [（ 54. 60 ± 10. 92） % ]（ P〈0. 05）. There was no significant difference between the groups in ICU residence time. However,the mechanical ventilation time was significantly shorter in nesiritide group[（ 3. 14 ± 1. 95） d] comparing with control group[（ 4. 29 ± 2. 25） d]（ P〈0. 05）.Conclusion Early application of nesiritide could alleviate myocardial injury and improve cardiac function after cardiac valve surgery.

关 键 词：奈西立肽 心脏瓣膜术 肌钙蛋白 肌酸激酶 

分 类 号：R542[医药卫生—心血管疾病]