心瓣膜疾病患者围手术期脑钠素浓度的变化  

Changes of the perioperative brain natriuretic peptide concentrations in patients undergoing cardiac valve replacement

作　　者：赖登祥[1] 张尔永[1] 王兰兰[2] 

机构地区：[1]四川大学华西医院胸心血管外科,成都610041 [2]四川大学华西医院实验医学科,成都610041

出　　处：《中国胸心血管外科临床杂志》2004年第2期103-105,共3页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的　观察心瓣膜置换术患者围手术期血清脑钠素 ( brain natriuretic peptide,BNP)浓度的变化规律。方法　 2 0例心瓣膜置换术患者按 NYHA心功能标准分级 ,术前进行超声心动图检查 ,测量左心室射血分数 ( L VEF) ,于术前、术后 2 4小时、7天、14天和 30天测量血清 BNP浓度 ,分析围手术期 BNP浓度变化趋势 ,术前 BNP浓度与心功能、L VEF的关系。　结果　心瓣膜疾病患者术后 BNP浓度急剧上升 ,2 4小时达峰值 ( P=0 .0 0 3) ;术后 7天明显下降 ,但仍高于术前水平 ( P=0 .0 15 ) ;术后 14天恢复至术前水平 ,术后 30天略低于术前水平。术前心功能 NYHA分级与 BNP水平呈正相关 ( r=0 .6 9,P<0 .0 5 ) ,L VEF与 BNP浓度无相关关系 ( r=0 .2 9,P>0 .0 5 )。　结论　术前血清BNP浓度能反映心瓣膜置换术患者术前心功能状况 ,血清 BNP浓度越高 ,心功能越差。术后早期 BNP浓度升高 。Objective To investigate the perioperative changes of serum brain natriuretic peptide (BNP) concentrations in patients undergoing cardiac valve replacement. Methods There were 20 patients admitted to the study, the serum BNP concentrations were measured before cardiac surgery, 24 hours, 7days, 14 days, and 30 days after operation. The preoperative NYHA cardiac function and the left ventricular ejection fraction(LVEF) were measured by echocardiogram. Results The preoperative BNP level was the baseline, it elevated markedly and acutely to a peak value 24 hours after operation ( P =0.003), then the BNP decreased 7 days later, but was still higher than the concentration before operation ( P =0.015), 14 days later it reached to the concentration before operation, 30 days later it was mild lower than preoperative BNP level, but there was no significant difference. There was a positive correlation between NYHA and BNP ( r =0.69, P <0.05), but no correlation between LVEF and BNP( r =0.29, P >0 05). Conclusion The preoperative serum BNP concentration can reflect the preoperative cardiac function in patients undergoing cardiac valve replacement, the high BNP level indicates the poor cardiac function. The BNP sharply elevated in the early time after operation, then gradually decreased in the late phase postoperation.

关 键 词：心瓣膜疾病 围手术期 脑钠素 心功能 

分 类 号：R654.2[医药卫生—外科学]