中华临床医师杂志(电子版)
中華臨床醫師雜誌(電子版)
중화림상의사잡지(전자판)
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2015年
14期
2690-2694
,共5页
张淑贤%史宏伟%葛亚力%魏海燕
張淑賢%史宏偉%葛亞力%魏海燕
장숙현%사굉위%갈아력%위해연
体外循环%超声心动描记术,经食管%利钠肽,脑
體外循環%超聲心動描記術,經食管%利鈉肽,腦
체외순배%초성심동묘기술,경식관%리납태,뇌
Extracorporeal circulation%Echocardiography,transesophageal%Natriuretic peptide,brain
目的:对需择期行二尖瓣置换术(MVR)的患者,初步研究体外循环(CPB)停机前后左心室功能及脑钠素(BNP)的变化。方法选取30例年龄30~73岁风湿性心脏病二尖瓣病变且需择期在CPB下行MVR的患者,以静脉麻醉诱导及维持,分别记录锯胸骨前(T1)、停CPB后5 min(T2)、停CPB后60 min(T3)时的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP),采用经食管超声心动图(TEE)技术监测上述时点的左心室射血分数(LVEF)、心指数(CI)、体循环阻力指数(SVRI)、二尖瓣舒张早期血流速度(E)与二尖瓣环舒张早期组织速度(E)的比值(E/E’)。检测T1、T3、术后12 h(T4)时的血中BNP浓度。结果 MAP在T2时[(64.4±9.4)mmHg]比T1时[(71.6±8.4)mmHg]明显下降(P<0.05),与T2相比,T3时[(73.7±7.2)mmHg]明显升高(P<0.01);CVP在T2时[(8.3±2.9)cmH2O]比T1时[(6.3±2.7)cmH2O]明显升高(P<0.05),T3时[(10.9±2.5)cmH2O]升高更加明显(P<0.01),T3时比T2时明显升高(P<0.01);SVRI在T2时[(1340±400)dyn?s?m2/cm5]比T1时[(1685±241)dyn?s?m2/cm5]明显下降(P<0.01),T3时[(1448±231) dyn?s?m2/cm5]仍然下降(P<0.05);血中BNP浓度与T1时[247.77(164.78,328.94)pg/ml]相比, T4时[341.33(224.68,445.9)pg/ml]升高(P<0.05),与T3时[184.01(135.53,259.92)pg/ml]相比, T4时亦升高明显(P<0.01)。结论对于CPB下行MVR患者,围术期均存在不同程度的舒张性心力衰竭,CPB停机早期体循环阻力明显下降,BNP水平与舒张功能减退具有良好的一致性。
目的:對需擇期行二尖瓣置換術(MVR)的患者,初步研究體外循環(CPB)停機前後左心室功能及腦鈉素(BNP)的變化。方法選取30例年齡30~73歲風濕性心髒病二尖瓣病變且需擇期在CPB下行MVR的患者,以靜脈痳醉誘導及維持,分彆記錄鋸胸骨前(T1)、停CPB後5 min(T2)、停CPB後60 min(T3)時的心率(HR)、平均動脈壓(MAP)、中心靜脈壓(CVP),採用經食管超聲心動圖(TEE)技術鑑測上述時點的左心室射血分數(LVEF)、心指數(CI)、體循環阻力指數(SVRI)、二尖瓣舒張早期血流速度(E)與二尖瓣環舒張早期組織速度(E)的比值(E/E’)。檢測T1、T3、術後12 h(T4)時的血中BNP濃度。結果 MAP在T2時[(64.4±9.4)mmHg]比T1時[(71.6±8.4)mmHg]明顯下降(P<0.05),與T2相比,T3時[(73.7±7.2)mmHg]明顯升高(P<0.01);CVP在T2時[(8.3±2.9)cmH2O]比T1時[(6.3±2.7)cmH2O]明顯升高(P<0.05),T3時[(10.9±2.5)cmH2O]升高更加明顯(P<0.01),T3時比T2時明顯升高(P<0.01);SVRI在T2時[(1340±400)dyn?s?m2/cm5]比T1時[(1685±241)dyn?s?m2/cm5]明顯下降(P<0.01),T3時[(1448±231) dyn?s?m2/cm5]仍然下降(P<0.05);血中BNP濃度與T1時[247.77(164.78,328.94)pg/ml]相比, T4時[341.33(224.68,445.9)pg/ml]升高(P<0.05),與T3時[184.01(135.53,259.92)pg/ml]相比, T4時亦升高明顯(P<0.01)。結論對于CPB下行MVR患者,圍術期均存在不同程度的舒張性心力衰竭,CPB停機早期體循環阻力明顯下降,BNP水平與舒張功能減退具有良好的一緻性。
목적:대수택기행이첨판치환술(MVR)적환자,초보연구체외순배(CPB)정궤전후좌심실공능급뇌납소(BNP)적변화。방법선취30례년령30~73세풍습성심장병이첨판병변차수택기재CPB하행MVR적환자,이정맥마취유도급유지,분별기록거흉골전(T1)、정CPB후5 min(T2)、정CPB후60 min(T3)시적심솔(HR)、평균동맥압(MAP)、중심정맥압(CVP),채용경식관초성심동도(TEE)기술감측상술시점적좌심실사혈분수(LVEF)、심지수(CI)、체순배조력지수(SVRI)、이첨판서장조기혈류속도(E)여이첨판배서장조기조직속도(E)적비치(E/E’)。검측T1、T3、술후12 h(T4)시적혈중BNP농도。결과 MAP재T2시[(64.4±9.4)mmHg]비T1시[(71.6±8.4)mmHg]명현하강(P<0.05),여T2상비,T3시[(73.7±7.2)mmHg]명현승고(P<0.01);CVP재T2시[(8.3±2.9)cmH2O]비T1시[(6.3±2.7)cmH2O]명현승고(P<0.05),T3시[(10.9±2.5)cmH2O]승고경가명현(P<0.01),T3시비T2시명현승고(P<0.01);SVRI재T2시[(1340±400)dyn?s?m2/cm5]비T1시[(1685±241)dyn?s?m2/cm5]명현하강(P<0.01),T3시[(1448±231) dyn?s?m2/cm5]잉연하강(P<0.05);혈중BNP농도여T1시[247.77(164.78,328.94)pg/ml]상비, T4시[341.33(224.68,445.9)pg/ml]승고(P<0.05),여T3시[184.01(135.53,259.92)pg/ml]상비, T4시역승고명현(P<0.01)。결론대우CPB하행MVR환자,위술기균존재불동정도적서장성심력쇠갈,CPB정궤조기체순배조력명현하강,BNP수평여서장공능감퇴구유량호적일치성。
Objective To investigate the change of left ventricular function and brain natriuretic peptide (BNP) of patients undergoing mitral valve replacement (MVR). Methods Thirty ASA Ⅱ-Ⅲpatients range in age from 30 to 73 years old, scheduled for MVR under CPB were involved. Anesthesia was induced and maintained with propofol. Heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP) was recorded before sternotomy (T1), at 5 min (T2) and 60 min (T3) after CPB, simultaneously left ventricular ejection fraction (LVEF), cardiac index (CI), systemic vascular resistance index (SVRI), the ratio of early diastolic mitral flow velocity (E) to early diastolic mitral annular tissue velocity (E)(E/E') were measured by transesophageal echocardiography (TEE). The BNP level was measured at T1, T3, 12 hours after surgery (T4). Results Compared with T1 (71.6±8.4)mmHg, MAP decreased significantly at T2 (64.4±9.4) mmHg (P<0.05), compared with T2, MAP increased significantly at T3 (73.7±7.2) cmH2O (P<0.01). Compared with T1 (6.3±2.7) mmHg, CVP increased significantly at T2 (8.3±2.9) cmH2O and T3 (10.9±2.5) cmH2O (P<0.05, P<0.01), compared with T2, CVP increased significantly at T3 (P<0.01). Compared with T1 (1 685±241) dyn?s?m2/cm5, SVRI decreased significantly at T2 (1 340±400) dyn?s?m2/cm5 and T3 (1 448±231) dyn?s?m2/cm5 (P<0.01, P<0.05). Compared with T1 [247.77(164.78, 328.94)pg/ml], the level of BNP increased significantly at T4 [341.33(224.68, 445.9)pg/ml] (P<0.05), compared with T3[184.01(135.53, 259.92)pg/ml], the level of BNP increased significantly at T4 (P<0.01). Conclusion For the patients undergoing MVR under CPB, diastolic heart failure was common, SVRI decreased significantly early after cardiopulmonary bypass, there was correlation between the level of BNP and diastolic dysfunction.