左心辅助循环后心肌功能恢复的预测研究  

Predicting the potential of myocardial recovery after left ventricular assist

作　　者：陆军[1] 肖学钧[1] 董辉[1] 成安衡[1] 黄焕雷[1] 

机构地区：[1]东莞市人民医院心胸外科,广东523000

出　　处：《中华胸心血管外科杂志》2004年第2期108-110,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的　研究急性缺血性左心功能不全时左心辅助装置 (LVAD)对左心功能的影响 ,筛选合适的心肌功能预后指标。方法　将 15只健康成年犬随机分为对照组 (A)、心衰组 (B)、辅助组 (C) ,仅对C组进行左心辅助。监测 6h内 3组实验犬的血流动力学指标及血浆心钠素 (ANP)、脑钠素 (BNP)、心肌肌钙蛋白I(cTnI)水平变化情况。结果　辅助组实验犬各项血流动力学指标明显改善 ,ANP、BNP、cTnI降至正常水平 ,心肌超微结构基本恢复正常。通过相关性分析 ,血浆BNP水平不受血流动力学变化影响。结论　血浆BNP更适于作为预测心肌功能恢复的预后指标。Objective: This study was undertaken to explore the effect of left ventricular assist device (LVAD) on failing heart after myocardial ischemia. By detecting the changes of plasma atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and cardiac troponin I (cTnI) levels within 6 hours after the implantation of LVAD, we review the basis on which neurohormones may be used to determine prognoses of failing heart and choose an optimal predictor. Methods: 15 adult healthy dogs were divided into 3 groups randomly. The LVAD was implanted in LA-AO bypass in all three groups. Myocardial ischemia was induced by ligating the main left anterior descending coronary artery (LAD). In group A, after a ligation of 10 minutes, the myocardium was reperfused for 6 hours. In group B, after a ligation of 40 minutes, the myocardium was reperfused for 6 hours. In group C, after a ligation of 40 minutes, the LVAD was used for LV support for 6 hours. Results: After 6 hours reperfusion,in group C, the hemodynamics was significantly improved, the ANP, BNP and cTnI were return to normal level, and myocardial ultrastructure was recovered significantly. While in group B, the hemodynamic, the neurohormones, and myocardial ultrastructure were worse. Relational analysis demonstrated that ANP and cTnI levels were influenced by hemodynamics obviously, but there was a weak relationship between circulating BNP and hemodynamics. Plasma BNP level was able to identify the cardiac function status. Conclusion: LVAD can be beneficial to improve cardiac function and can reduce the plasma levels of ANP, BNP and cTnI. Plasma BNP level can identify the cardiac function status. Those findings indicated that plasma BNP determination provides important prognostic information about cardiac function and may be a better prognostic indicator.

关 键 词：左心辅助循环 心肌功能恢复 预测 急性缺血性左心功能不全 血液动力学 心钠素 肌钙蛋白Ⅰ 

分 类 号：R654.2[医药卫生—外科学]