重组人脑利钠肽对小儿行全腔静脉-肺动脉吻合术后出院时间及胸腔积液的影响  

Impact of rhBNP infusion on early postoperative recovery after total cavo-pulmonary connection surgery

作　　者：段亚冰 张雅娟 王菊 闫军[1] 

机构地区：[1]国家心血管病中心阜外医院小儿心外科中国医学科学院北京协和医学院,100037

出　　处：《中华胸心血管外科杂志》2017年第12期708-711,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 比较小儿行全腔静脉-肺动脉吻合术术后应用重组人脑利钠肽（rhBNP,中文商品名：新活素）对出院时间及胸腔积液的影响,为术后患儿的临床治疗提供更合理的方法.方法 回顾性分析2016年1月至2017年1月40例因复杂先天性心脏病行TCPC的患儿临床资料,其中5例因术后血栓形成或术后腔静脉压力过高而行二次Fontan手术,予以排除.其中9例患儿术后返回病房后在强心、利尿等常规治疗基础上应用剂量不等的rhBNP（3～11天）,为rhBNP组,26例常规治疗的患儿为常规治疗组.对比两组患儿术后早期生存率、住院天数、胸腔引流留置时间的情况.结果 两组患儿术前检查均符合TCPC手术指征,患儿术中体外循环,术后呼吸机使用,ICU滞留及正性肌力药物评分差异无统计学意义（P〉0.05）.术后35例患儿均生存且康复出院,rhBNP组患儿术后住院11～33天,平均19.2天,中位值18天;常规治疗组术后9～95天,平均34.4天,中位值28天,两组间差异有统计学意义（P=0.038）.rhBNP组患儿中位胸腔引流管留置14天（9～27天,平均15.6天）,常规治疗组23天（7～91天,平均30.9天）,组间差异有统计学意义（P=0.046）,所有患儿用药期间及用药后均未出现液体负荷过重、顽固性低血压、肝肾功能损伤等不良反应.结论 rhBNP可安全用于小儿心脏手术后,与常规治疗组相比,rhBNP在小儿行TCPC后早期出院和胸腔引流管拔除时间上有优势.Objective To compare the effects of rhBNP on the discharge time and pleural effusion in children with total cavo-pulmonary connection, and to provide a more reasonable method for the clinical treatment of postoperative children. Meth-ods Retrospective analysis of Jan 2016 to Jan 2017 during the hospital 40 cases of complex congenital heart disease in children with total cavo-pulmonary connection clinical data, of which 5 cases due to postoperative thrombosis or postoperative venous pressure was too high and had a second Fontan surgery, the patients excluded from the inclusion criteria. 9 cases of children re-turned to the ward after surgery, such as cardiac, diuretic and other conventional treatment based on the application of unequal dose of rhBNP（3-11 days） for the rhBNP group, 26 cases of conventional treatment of children with conventional treatment group. By comparing the early postoperative survival rate, the number of days of hospital stay and the retention time of the tho-racic drainage between the two groups. Results There were no significant differences in the time of cardiopulmonary bypass, postoperative ventilator use time, ICU time and positive inotropic drug scores in all the two groups. All the patients underwent preoperative examination with total cavo-pulmonary connection were alive and healthy discharge. The median hospital stay was 18 days in the rhBNP group（11-33 days, mean 19. 2 days）, and the median length of hospital stay was 28 days in the routine treatment group（9 to 95 days, mean 34. 4 days）. The difference of hospitalization days between the two groups was statistically significant（P=0. 038）. In the retention time of the thoracic drainage tube, the median thoracic drainage tube retention time was 14 days（9-27 days, mean 15. 6 days） in the rhBNP group and 23 days in the conventional treatment group（7-91 days, mean 30. 9（P=0. 046）. All the patients had no adverse effects such as excessive fluid load, intractable hypotension and liver or kidney function injury. Co

关 键 词：全腔静脉-肺动脉吻合术 重组人脑利钠肽 胸腔引流 

分 类 号：R726.5[医药卫生—儿科]