CAJ | 학술논문

目的：观察心脏瓣膜术后早期应用奈西立肽对心肌损伤及心功能的保护作用。方法连续收集2013年11月～2015年2月四川省人民医院心外科收治的心脏瓣膜病患者78例，随机分为奈西立肽组（n＝38）和对照组（n＝40）。奈西立肽组患者在术后常规心肌保护治疗的基础上给予24～72 h的奈西立肽[0.01μg／（kg· min）]治疗。对照组患者术后仅接受常规心肌保护治疗。观察指标：①心肌肌钙蛋白（ cTnI）、磷酸肌酸激酶同工酶（ CK-MB）：分别在术前、术后0、24、72 h抽取静脉血检测；②患者血肌酐（ SCr）：分别在术前、术后7 d抽取静脉血检测；③左室射血分数（ LVEF）：分别在术前、术后7 d行超声心动图测定；④ICU停留时间及机械辅助通气时间。结果2组患者术后24 h cTnI及CK-MB差异无统计意义；奈西立肽组术后72 h cTnI为（5.10±2.03）ng／mL，显著低于对照组的（8.94±3.35）ng／mL（P＜0.05），奈西立肽组CK-MB为（36.27±12.18）U／L，显著低于对照组的（23.24±14.67）U／L （P＜0.05）；2组患者术后7 d的SCr水平差异无统计学意义；术后7 d奈西立肽组LVEF为（60.47±8.60）％，较对照组（54.60±10.92）％明显改善（P＜0.05）；2组患者ICU停留时间差异无统计学意义，但奈西立肽组机械辅助通气时间[（3.14±1.95）d]明显短于对照组[（4.29±2.25）d，P＜0.05]。结论心脏瓣膜术后早期应用奈西立肽可减轻心肌损伤，改善心脏功能。
목적：관찰심장판막술후조기응용내서립태대심기손상급심공능적보호작용。방법련속수집2013년11월～2015년2월사천성인민의원심외과수치적심장판막병환자78례，수궤분위내서립태조（n＝38）화대조조（n＝40）。내서립태조환자재술후상규심기보호치료적기출상급여24～72 h적내서립태[0.01μg／（kg· min）]치료。대조조환자술후부접수상규심기보호치료。관찰지표：①심기기개단백（ cTnI）、린산기산격매동공매（ CK-MB）：분별재술전、술후0、24、72 h추취정맥혈검측；②환자혈기항（ SCr）：분별재술전、술후7 d추취정맥혈검측；③좌실사혈분수（ LVEF）：분별재술전、술후7 d행초성심동도측정；④ICU정류시간급궤계보조통기시간。결과2조환자술후24 h cTnI급CK-MB차이무통계의의；내서립태조술후72 h cTnI위（5.10±2.03）ng／mL，현저저우대조조적（8.94±3.35）ng／mL（P＜0.05），내서립태조CK-MB위（36.27±12.18）U／L，현저저우대조조적（23.24±14.67）U／L （P＜0.05）；2조환자술후7 d적SCr수평차이무통계학의의；술후7 d내서립태조LVEF위（60.47±8.60）％，교대조조（54.60±10.92）％명현개선（P＜0.05）；2조환자ICU정류시간차이무통계학의의，단내서립태조궤계보조통기시간[（3.14±1.95）d]명현단우대조조[（4.29±2.25）d，P＜0.05]。결론심장판막술후조기응용내서립태가감경심기손상，개선심장공능。
Objective To identify the protective effects of early application of nesiritide on myocardial injury and cardiac function after cardiac valve surgery.Metheds 78 patients with cardiac valve surgery in the hospital from November 2013 to February 2015 were randomly divided into nesiritide group(n=38) and control group(n=40).Nesiritide group received the routine treatment plus 24-72 hour treatment of nesiritide [0.01 ug/(kg · min)], and control group received only the routine treatment.Observation index:①Cardiac troponin (cTnI) and MB isoenzyme of creatine kinase (CK-MB): venous blood was tested before and after operation 0h, 24 h and 72 h;②Serum creatinine (SCr): venous blood was tested before and after surgery 7 days;③Left ventricular ejection fraction ( LVEF): echocardiography was done before and after operation 7 days;④ICU residence time and mechanical ventilation time.Results There was no significant difference between two groups in cTnI and CK-MB at 24 hour after operation.However, at 72 hour after operation, cTnI in nesiritide group was(5.10 ±2.03)ng/mL, lower than that in control group[(8.94 ±3.35)ng/mL,P<0.05];CK-MB in nesiritide group was (23.24 ±14.67U/L), lower than that in control group[(36.27 ±12.18)U/L,P<0.05].There was no significant difference in SCr level between two groups after operation.At 7 day after operation, LVEF improved significantly in nesiritide group[(60.47 ±8.60)%] comparing with control group [(54.60 ±10.92)%] (P <0.05).There was no significant difference between the groups in ICU residence time.However, the mechanical ventilation time was significantly shorter in nesiritide group[(3.14 ±1.95)d] comparing with control group[(4.29 ±2.25)d](P<0.05). Conclusion Early application of nesiritide could alleviate myocardial injury and improve cardiac function after cardiac valve surgery.