氨基末端脑钠肽前体与高敏C反应蛋白及肌酸激酶同工酶对非体外循环不停跳下冠状动脉旁路移植术后新发心房颤动的评估价值  

Evaluation of NT-proBNP,hs-CRP and CK-MB in new-onset atrial fibrillation after off-pump coronary artery bypass grafting

作　　者：贺元辰 韩宏光 徐莉莹 张晓慧 孙畅 HE Yuan-chert;HAN Hong-guang;XU Li-ying;ZHANG Xiao-hui;SUN Chang(Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院心外科,辽宁省沈阳市110016

出　　处：《中国心血管病研究》2020年第1期31-36,共6页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨术前氨基末端脑钠肽前体(NT・proBNP)、高敏C反应蛋白(hs-CRP).肌酸激酶同工酶(CK-MB)对非体外循环不停跳下冠状动脉旁路移植(OPCAB)术后新发心房颤动(POAF)的评估价值。方法回顾性分析2018年6月至2019年2月在北部战区总医院心脏外科首次择期行单纯OPCAB患者的临床资料。共收集320例术前为窦性心律的患者,根据术后是否发生心房颤动(AF)将患者分为心房颤动组(AF组,85例)与非心房颤动组(NAF组,235例),记录两组患者的超声心动图指标(LAD、LVEDD、LVESD、LVEF)、患者实验室检验结果(NT・proBNP、hs・CRP、CK・MB)以及相关围术期临床资料,分析比较两组各项指标的差异。结果AF组与NAF组患者相比,AF组患者年龄较大(£=9.327,PvO.OOl)、左心房内径(LAD)较大(/=6.702,PV0.001)、左心室射血分数(LVEF)较低(尸6.333,P<0.001)、术前血氧饱和度(SpO?)较低(£=3.309,P<0.001)、术前cTnT、NT-proBNP、hs-CRP及CK-MB水平较高(分别为£=12.518,P<0.001;«=9.578,P<0.001;£=6.655,Pv0.001;£=23.072,Pv0.001)、机械辅助通气时间较长(£=5.004,P<0.001),差异有统计学意义(PV0.001),其他指标差异均无统计学意义(P>0.05)o经多变量hg诚c回归分析得出,0PCAB术后POAF的独立预测因素分别是年龄、LAD、SpO2、LVEF、cTnT、NT・proBNP和hs・CRP。结论年龄、LAD、NT-proBNP.LVEF、cTnT、hs・CRP、SpCh等是OPCAB术后POAF的独立预测因素,且术前NT-proBNP.hs-CRP等指标对OPCAB术后POAF具有较高的临床评估作用。Objective To investigate the effect of preoperation N-terminal pro-brain natriuretic peptide(NT-proBNP),high-sensitivity C-reactive protein(hs-CRP)and creatinine kinase myocardial enzyme(CK-MB)for postoperative AF(POAF)in patients undergoing ofTpump coronary artery bypass grafting(OPCAB).Methods The clinical data of patients undergoing coronary artery bypass grafting without cardiopulmonary bypass were retrospectively analyzed from June 2018 to February 2019 in the Department of Cardiac Surgery,General Hospital of Northern Theater Command.A total of 320 patients with preoperative sinus rhythm were enrolled.Patients were divided into AF group(AF group,n=85)and NAF group(NAF group,n=235).The cardiac ultrasound index(LAD,LVEDD,LVESD,LVEF),laboratory test results(NT-proBNP,hs-CRP,CK-MB)and related perioperative clinical data of the two groups were recorded and the differences between the two groups were compared.Results Compared with the NAF group,the patients in the AF group were older(/=9.327,P<0.001)and with the larger left atrial diameter(LAD)(/=6.702,P<0.001),the lower left ventricular ejection fraction(LVEF)(￡=6.333,P<0.001),the lower preoperative oxygen saturation(SpO2)(￠=3.309,P<0.001),and the preoperation levels of cTnT,NT-proBNP,hs-CRP and CK-MB higher(z=12.518,PvO.001;t=9.578,PvO.001;￡=6.655,P<0.001;/=23.072,P<0.001).The time of mechanical assisted ventilation was longer(/=5.004,P<0.001)and the difference was statistically significant(P<0.001).There was no significant difference in other indexes(P>0.05).Multivariate Logistic regression analysis showed that independent predictors of POAF after OPCAB were age,LAD,SpCh,LVEF,cTnT,NT-proBNP and hs-CRP.Conclusion The age,LAD,NT-proBNP,LVEF,cTnT,hs-CRP and SpCh were the independent predictors of POAF after OPCAB.Preoperative NT-proBNP and hs-CRP have higher clinical evaluation.

关 键 词：新发心房颤动 非体外循环下冠状动脉旁路移植术 氨基末端脑钠肽前体 高敏C反应蛋白 肌酸激酶同工酶 

分 类 号：R541.7[医药卫生—心血管疾病]