非体外冠状动脉旁路移植患者术后血浆B型脑钠肽变化与术后早期心功能不全的相关性研究  

Related research of plasma B-type natriuretic peptide and early postoperative cardiac insufficiency after off pump coronary artery bypass grafting

作　　者：张明[1] 刘楠[1] 李菁[2] 崔颖[3] ZHANG Ming;LIU Nan;LI Jing;CUI Ying(Department of Center for Cardiac Intensive Care,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科危重症中心,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所超声心动一部,100029 [3]北京市第一社会福利院

出　　处：《心肺血管病杂志》2020年第1期40-43,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市医院管理局计划(XMLX201822)。

摘　　要：目的:探讨血浆BNP术后早期变化对冠心病患者行非体外冠状动脉旁路移植术(OPCABG)后早期心功能不全发生率的预测价值。方法:回顾性分析北京安贞医院2019年1月至2019年8月,行OPCABG后ICU内监护的患者288例,分别测量患者术后即刻、术后24 h、术后48 h血浆BNP水平,计算术后第一天(△24 h)及第二天(△48 h)的血浆BNP动态变化率,分析BNP动态变化率与术后早期心功能不全之间的关系,并通过受试者工作特征曲线(ROC)分析其对于OPCABG患者发生术后早期心功能不全的预测价值。结果:共入选288例患者,其中术后早期心功能不全组(心功能不全组)27例,未发生早期心功能不全组(对照组)261例。对照组△24 h BNP[5.61(-87.50,141.40)ng/L]低于心功能不全组[180.56(67.00,389.00)ng/L](P<0.05)。△48 h BNP两组间差异无统计学意义。对照组△24 h BNP%及△48 h BNP%[8.48(5.74,9.95)%、10.64(5.23,10.17)%]均低于心功能不全组[50.63(24.50,81.26)%、28.73(11.98,40.18)%](P均<0.05)。△24 h BNP%预测术后早期心功能不全成功AUCROC为0.812(95%CI:0.716~0.908)(P<0.001),最佳诊断值为18.05%,敏感性为76.6%,特异性为80.0%。结论:术后早期△24 h BNP%与OPCABG患者术后早期发生心功能不全密切相关,△24 h BNP%越低,术后早期发生心功能不全的可能性越小,对评估和预测OPCABG术后并发症有重要意义。Objective:Explored the value of plasma BNP change rate in predicting the incidence of early postoperative cardiac insufficiency after off pump coronary artery bypass grafting(OPCABG)in patients with coronary heart disease.Methods:In total,288 patients’retrospective analysis of ICU after CABG in Beijing An Zhen Hospital from January 2019 to August 2019.The plasma BNP levels were measured immediately,24 hours and 48 hours after operation.The dynamic changes of BNP on the first day(△24 h)and the second day(△48 h)were calculated,to analyze the relationship between the dynamic rate of BNP and the early postoperative cardiac dysfunction,and to analyze the predictive value of ROC for the early postoperative cardiac dysfunction in patients with OPCABG.Results:A total of 288 patients were enrolled,including 27 patients in the early cardiac insufficiency group(the cardiac insufficiency group)and 261 patients in the non early cardiac insufficiency group(the control group).△24 h BNP in the control group[5.61(-87.50,141.40)ng/L]was lower than that in the heart failure group[180.56(67.00,389.00)ng/L](P<0.05).There was no significant difference in BNP between the two groups.△24 h BNP%and△48 h BNP%in the control group[50.63(24.50,81.26)%、28.73(11.98,40.18)%]were lower than that in the group of cardiac insufficiency[8.48(5.74,9.95)%、10.64(5.23,10.17)%](P<0.05).△24 h BNP%predicted that AUCROCwas 0.812 for early postoperative cardiac failure(95%CI:0.716-0.908;P<0.001),optimal diagnostic value was 18.05%,the sensitivity was 76.7%,and the specificity was 80.0%.Conclusions:Early postoperative BNP%of△24 h is closely related to early postoperative cardiac dysfunction in patients with OPCABG.△24 h BNP%is the lower,the less likely early postoperative cardiac dysfunction will occur.which is of great significance to evaluate and predict postoperative complications of OPCABG.

关 键 词：B型脑钠肽 非体外循环冠状动脉旁路移植术 心功能不全 预后 

分 类 号：R54[医药卫生—心血管疾病]