风湿性左房室瓣狭窄并肺动脉高压患者围术期血浆内皮素1、环磷酸腺苷水平变化及其与肺动脉收缩压的相关性研究  

Change of Perioperative Plasma Levels of ET-1 and cAMP in Rheumatic Left Atrioventricular Stenosis Patients Merged with PAH and the Correlations with SPAP

作　　者：谭何易 唐胜军[1] 杨超[1] 唐烽[1] 向舒[1] TAN He-yi;TANG Sheng-jun;YANG Chao;TANG Feng;XIANG Shu

机构地区：[1]重庆三峡中心医院胸外科,重庆市404000

出　　处：《实用心脑肺血管病杂志》2018年第7期34-39,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的分析风湿性左房室瓣狭窄并肺动脉高压(PAH)患者围术期血浆内皮素1(ET-1)、环磷酸腺苷(cAMP)水平变化及其与肺动脉收缩压(SPAP)的相关性。方法选取2015年3月—2016年9月重庆三峡中心医院收治的风湿性左房室瓣狭窄并PAH患者29例,均行体外循环(CPB)下左房室瓣置换术,并根据SPAP分为A组(轻度PAH,n=9)、B组(中度PAH,n=13)、C组(重度PAH,n=7)。比较3组患者临床特征及麻醉诱导前(T_1)、CPB停止即刻(T_2)、术后12 h(T_3)、术后24 h(T_4)、术后48 h(T_5)、术后72 h(T_6)、术后120 h(T_7)、术后168 h(T_8)血浆ET-1、cAMP水平;T_1时血浆ET-1、cAMP水平与风湿性左房室瓣狭窄并PAH患者SPAP的相关性分析采用线性回归分析。结果 (1)3组受试者左房室瓣狭窄情况、左心房血栓形成者所占比例及心房颤动发生率比较,差异有统计学意义(P<0.05)。(2)C组患者T_1～T_8时血浆ET-1水平高于A组、B组,B组患者T_1、T_4～T_8时血浆ET-1水平高于A组(P<0.05);3组患者围术期血浆ET-1水平呈现先升高后逐渐降低趋势。(3)C组患者T_1～T_8时血浆cAMP水平高于A组、B组,B组患者T_1～T_8时血浆cAMP水平高于A组(P<0.05);3组患者围术期血浆cAMP水平呈现逐渐降低趋势。(4)线性回归分析结果显示,T_1时血浆ET-1、cAMP水平与风湿性左房室瓣狭窄并PAH患者SPAP呈正相关(R^2分别为0.77、0.89)。结论不同SPAP风湿性左房室瓣狭窄并PAH患者病情严重程度不同,患者围术期血浆ET-1水平呈现先升高后逐渐降低趋势,血浆cAMP水平呈现逐渐降低趋势,且麻醉诱导前血浆ET-1、cAMP水平与SPAP均呈正相关。Objective To analyze the change of perioperative plasma levels of ET-1 and cAMP in rheumatic left atrioventricular stenosis patients merged with PAH and the correlations with SPAP.Methods A total of 29 rheumatic left atrioventricular stenosis patients merged with PAH were selected in Chongqing Three Gorges Central Hospital from March 2015 to September 2016,all of them received cardiac pulmonary bypass(CPB)guided left atrioventricular valve replacement,and they were divided into A group(with mild PAH,n=9),B group(with moderate PAH,n=13)and C group(with severe PAH,n=7)according to the SPAP.Clinical features,plasma levels of ET-1 and cAMP before anesthesia induction(T1),immediately after CPB(T2),12 hours after surgery(T3),24 hours after surgery(T4),48 hours after surgery(T5),72 hours after surgery(T6),120 hours after surgery(T7)and 168 hours after surgery(T8);linear-regression analysis was used to analyze the correlations of plasma levels of ET-1 and cAMP at T1 with SPAP in rheumatic left atrioventricular stenosis patients merged with PAH.Results (1)There were statistically significant differences of left atrioventricular stenosis status,incidence of left atrial thrombosis and atrial fibrillation in the three groups(P<0.05).(2)Plasma ET-1 level in C group was statistically significantly higher than that in A group and B group at T1-T8,respectively,meanwhile plasma ET-1 level in B group was statistically significantly higher than that in A group at T1,T4-T8,respectively(P<0.05);perioperative plasma ET-1 level in the three groups showed a trend of increasing first and then decreasing gradually,respectively.(3)Plasma cAMP level in C group was statistically significantly higher than than in A group and B group at T1-T8,respectively,meanwhile plasma cAMP level in B group was satisfaction significantly higher than that in A group at T1-T8,respectively(P<0.05);perioperative plasma cAMP level in the three groups showed a trend of gradually decreasing,respectively.(4)Linearregression analysis results showed that,plasma level

关 键 词：高血压 肺性 风湿性心脏病 内皮素1 环磷酸腺苷 

分 类 号：R544[医药卫生—心血管疾病] R541.2[医药卫生—内科学]