CAJ | 학술논문

目的探讨沿海居民血浆B型钠尿肽(B-type natriuretic peptide,BNP)在心脏手术前后的变化情况及意义.方法 100例心脏手术患者,其中40例为非体外循环下行冠状动脉搭桥术的冠心病患者,60例为体外循环下行心脏瓣膜置换术的风心病患者,分别于术前,术后即刻,术后24 h,4、8、30 d测定血浆BNP浓度;超声心动图测定左心室射血分数(LVEF).结果冠心病和风心病患者术前血浆BNP浓度均明显高于正常组(P<0.01),术后即刻与术前相似,此后迅速上升,24 h达到高峰.然后开始随病情的恢复逐渐下降,术后8 d尚未降到术前水平,术后30 d明显低于术前水平,差异有统计学意义(P<0.01).心功能分级之间BNP差异显著,与心功能分级呈正相关(r=0.455,P<0.01),与LVEF呈负相关(r=-0.122,P<0.01).结论血浆BNP浓度在体外循环和非体外循环下心脏手术中的变化相似,体外循环期间BNP没有进一步升高,且与NYHA心功能分级、LVEF呈较好的相关性,能敏感而特异地反映心功能.
목적 탐토연해거민혈장B형납뇨태(B-type natriuretic peptide,BNP)재심장수술전후적변화정황급의의.방법 100례심장수술환자,기중40례위비체외순배하행관상동맥탑교술적관심병환자,60례위체외순배하행심장판막치환술적풍심병환자,분별우술전,술후즉각,술후24 h,4、8、30 d측정혈장BNP농도;초성심동도측정좌심실사혈분수(LVEF).결과 관심병화풍심병환자술전혈장BNP농도균명현고우정상조(P<0.01),술후즉각여술전상사,차후신속상승,24 h체도고봉.연후개시수병정적회복축점하강,술후8 d상미강도술전수평,술후30 d명현저우술전수평,차이유통계학의의(P<0.01).심공능분급지간BNP차이현저,여심공능분급정정상관(r=0.455,P<0.01),여LVEF정부상관(r=-0.122,P<0.01).결론 혈장BNP농도재체외순배화비체외순배하심장수술중적변화상사,체외순배기간BNP몰유진일보승고,차여NYHA심공능분급、LVEF정교호적상관성,능민감이특이지반영심공능.
Objeotive To investigate the variation and significance of plasma type B natriuretic peptide (BNP) before and after cardiac surgery.Methods There were altogether 100 cases, of which 40 were patients with coronary heart disease who received intracorporeal coronary artery bypass surgery and 60 were patients with rheumatic heart disease who received extracorporeal cardiac valve replacement surgery.BNP levels were tested immediately before and after surgery,24 hours,4 days,8 days and 30 days after operation respectively. Ultrasonography was performed to test LVEF.Results Plasma BNP levels of patients with coronary heart disease and rheumatic heart disease were significantly higher than that of the normal group (P<0.01),the levels of BNP tested immediately after operation were similar to that before operation,the plasma levels of BNP elevated obviously and reached peak at hour 24,then dropped gradually with recovery of the disease.Plasma BNP did not come back to the level before operation.BNP level 30 days after surgery wsa obviously lower than that before surgery,with statistical significance (P<0.01),however,it was still higher than that of the control group. Similar changes could be seen in variations of plasma BNP in intracorporeal coronary artery bypass surgery and extracorporeal cardiac valve replacement surgery.BNP did not increase during extracorporeal circulation.BNP levels were significantly different in different levels of NYHA.Results showed that BNP levels were positively correlated with NYHA(r=0.455,P<0.01),while they were negatively correlated with LVEF (r=-0.122,P<0.01).Conclusions Similar changes were seen in variations of plasma BNP in intracorporeal coronary artery bypass surgery and extracorporeal cardiac valve replacement surgery.BNP did not increase further during extracorporeal circulation having appropriate correlation with the classification of NYHA and LVEF.The cardiac function of patients could revealed sensitively and specifically.