CAJ | 학술논문

目的：观察冠状动脉旁路移植术前后氨基末端B型脑钠肽（N-terminal pro-brain natriuretic peptide, Nt-proBNP）、高敏C反应蛋白（hs-CRP）的变化及对术后早期并发症和术后房颤的预测价值。方法回顾分析75例常规体外循环冠状动脉旁路移植术（CCABG）和44例非体外循环冠状动脉旁路移植术（OPCAB）患者手术前后24 h Nt-proBNP、hs-CRP水平变化及其对术后早期并发症和术后房颤的预测价值。结果术后24 h 2组Nt-proBNP和hs-CRP均明显升高（P<0.001）。术前Nt-proBNP 水平与左室射血分数呈负相关（r=-0.43，P<0.001）。经单因素和多因素logistic回归分析显示，术前左室射血分数减低和术后24 h Nt-proBNP明显升高是术后心力衰竭、低心排综合征的独立预测因子。结论冠状动脉旁路移植术后24 h Nt-proBNP明显升高、术前左室射血分数减低可预测术后早期心力衰竭、低心排并发症的发生；对术后新发房颤无预测价值。
목적：관찰관상동맥방로이식술전후안기말단B형뇌납태（N-terminal pro-brain natriuretic peptide, Nt-proBNP）、고민C반응단백（hs-CRP）적변화급대술후조기병발증화술후방전적예측개치。방법회고분석75례상규체외순배관상동맥방로이식술（CCABG）화44례비체외순배관상동맥방로이식술（OPCAB）환자수술전후24 h Nt-proBNP、hs-CRP수평변화급기대술후조기병발증화술후방전적예측개치。결과술후24 h 2조Nt-proBNP화hs-CRP균명현승고（P<0.001）。술전Nt-proBNP 수평여좌실사혈분수정부상관（r=-0.43，P<0.001）。경단인소화다인소logistic회귀분석현시，술전좌실사혈분수감저화술후24 h Nt-proBNP명현승고시술후심력쇠갈、저심배종합정적독립예측인자。결론관상동맥방로이식술후24 h Nt-proBNP명현승고、술전좌실사혈분수감저가예측술후조기심력쇠갈、저심배병발증적발생；대술후신발방전무예측개치。
Objective To examine the change of N-terminal pro-brain natriuretic peptide (Nt-proBNP) and high sensitive C reactive protein (hs-CRP) in patients underwent coronary artery bypass grafting and to evaluate their value as risk predictors for postoperative complications and atrial fibrillation. Methods Seventy-five patients underwent coronary artery bypass grafting under on-pump (CCABG) and 44 patients underwent off-pump bypass grafting (OPCAB). The levels of Nt-proBNP and hs-CRP were monitored before and 24 h after operation in all patients. Results The serum levels of hs-CRP and Nt-proBNP were significantly higher in 24 h after operation (P<0.001). The level of Nt-proBNP before oper-ation was negatively correlated with left ventricular ejection fraction (r = -0.43,P < 0.001). By univariate and multivariate logistic regression analysis, multivariable predictors including Nt-proBNP 24 h after operation and left ventricular ejection fraction were significantly associated with a more frequent postoperative congestive heart failure and low cardiac output. Conclusion Nt-proBNP and hs-CRP after CABG is increased significantly. Nt-proBNP after op-eration and left ventricular ejection fraction are postoperative complication risk predictors, but has no predictive value for postoperative atrial fibrillation in patients undergoing CABG.