CAJ | 학술논문

目的：探讨心脏瓣膜置换患者围手术期血清 N-末端脑尿钠肽原（NT-proBNP）检测的临床意义。方法测定296例心脏瓣膜置换患者围手术期血浆 NT-proBNP 水平，分析术前血浆 NT-proBNP 水平与心功能分级的关系，观察术后变化情况，比较死亡和有并发症患者及无并发症患者围手术期血浆 NT-proBNP 水平。结果术前不同心功能分级患者左心室射血分数（LVEF）和血浆 NT-proBNP 水平比较，差异均有统计学意义（F 分别为5.268、8.173，P ＜0.05），术前血清 BNP 水平与心功能分级呈正比（r＝0.776，P ＜0.01），与患者的 LVEF 呈反比（r＝－0.472，P ＜0.05）；术后第1天血浆 NT-proBNP 水平达到峰值，与术前比较差异有统计学意义（t＝20.913，P ＜0.05）），术后第3、5、7天逐渐下降。死亡和有并发症患者术前血浆 NT-proBNP 水平及术后血浆 NT-proBNP 峰值水平均高于无并发症组，差异有统计学意义（P ＜0.05）。结论心脏瓣膜置换术患者术前血浆 NT-proBNP 浓度能够反映心功能情况，术后血浆 NT-proBNP 水平早期升高，然后逐渐下降，术前及术后血浆 NT-proBNP 浓度升高对预测患者的转归有一定临床价值。
목적：탐토심장판막치환환자위수술기혈청 N-말단뇌뇨납태원（NT-proBNP）검측적림상의의。방법측정296례심장판막치환환자위수술기혈장 NT-proBNP 수평，분석술전혈장 NT-proBNP 수평여심공능분급적관계，관찰술후변화정황，비교사망화유병발증환자급무병발증환자위수술기혈장 NT-proBNP 수평。결과술전불동심공능분급환자좌심실사혈분수（LVEF）화혈장 NT-proBNP 수평비교，차이균유통계학의의（F 분별위5.268、8.173，P ＜0.05），술전혈청 BNP 수평여심공능분급정정비（r＝0.776，P ＜0.01），여환자적 LVEF 정반비（r＝－0.472，P ＜0.05）；술후제1천혈장 NT-proBNP 수평체도봉치，여술전비교차이유통계학의의（t＝20.913，P ＜0.05）），술후제3、5、7천축점하강。사망화유병발증환자술전혈장 NT-proBNP 수평급술후혈장 NT-proBNP 봉치수평균고우무병발증조，차이유통계학의의（P ＜0.05）。결론심장판막치환술환자술전혈장 NT-proBNP 농도능구반영심공능정황，술후혈장 NT-proBNP 수평조기승고，연후축점하강，술전급술후혈장 NT-proBNP 농도승고대예측환자적전귀유일정림상개치。
Objective To explore the clinical significance of perioperative serum N-terminal pro-BNP(NT-proBNP)testing in patients with cardiac valve replacement.Methods The content of perioperative plasma NT-proBNP in 296 patients with cardiac valve replacement was detected,the relationship between preoperative plasma NT-proBNP content and heart function classification was analyzed,the postoperative changes were observed and the plasma NT-proBNP levels were compared among the death cases, the patients with complications and without complications.Results The left ventricular ejection fraction(LVEF)and plasma NT-proBNP content had statistical differences among different cardiac functional classifications(F =5.268,8.173,P <0.05),preopera-tive serum NT-proBNP level was positively proportional to the cardiac function classification(r =-0.776,P <0.01)and inversely proportional to LVEF(r=-0.472,P <0.05);on postoperative 1 d,plasma content of NT-proBNP reached the peak,there was sta-tistically significant difference compared with before treatment,(t=20.913,P <0.05),then which was gradually declined on post-operative 3,5,7 d.The preoperative plasma NT-proBNP content and postoperative plasma NT-proBNP peak levels in the death pa-tients and the patients with complications were higher than those in the patients without complications(P <0.05 ),the difference was statistically significant(P <0.05 ).Conclusion Preoperative plasma NT-proBNP concentration in the patients with cardiac valve replacement can reflect the cardiac function condition,the postoperative plasma NT-proBNP content is increased at the early stage,then gradually decreased,The increase of plasma NT-proBNP concentration before and after operation has a certain clinical value in predicting prognosis of the patients.