中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2015年
10期
600-603
,共4页
赵福梅%陈彤云%孙静%刘建实
趙福梅%陳彤雲%孫靜%劉建實
조복매%진동운%손정%류건실
二尖瓣%心脏瓣膜假体植入%肺动脉高压%重组脑利钠肽%前列腺素E1
二尖瓣%心髒瓣膜假體植入%肺動脈高壓%重組腦利鈉肽%前列腺素E1
이첨판%심장판막가체식입%폐동맥고압%중조뇌리납태%전렬선소E1
Mitral valve%Heart valve posthesis implantation%Pulmonary hypertension%Natriuretic peptides Prostaglandin E1
目的 比较人重组脑钠肽(rhBNP)与前列腺素E1(PGE1)对二尖瓣置换(MVR)术后肺动脉高压的治疗效果.方法 60例MVR术后平均肺动脉压≥25 mmHg(1 mmHg=0.133 kPa)的患者,随机分为对照组、PGE1组及rhBNP组,每组20例.3组分别于用药前、用药后1、6、24 h以及停药后2h监测患者的血流动力学参数,并记录患者一般资料、术中情况及术后机械通气时间;于用药前、用药后24 h、术后1周、3个月检测患者的外周静脉血血栓素(TXA2)与环磷酸鸟苷(cGMP)水平.结果 PGE1组的机械通气时间小于对照组和rhBNP组.PGE1组给药后1h患者的平均动脉压、平均肺动脉压(mPAP)、肺循环血管阻力指数(PVRI)、肺血管楔嵌压(PAWP)降低,停药后上述指标反弹;rhBNP组给药后6h出现mPAP、PRVI、PAWP降低,mPAP下降幅度小于PGE1组.对照组术后TXA2下降,cGMP上升;PGE1组和rhBNP组给药24h后TXA2下降和cGMP升高幅度均大于对照组.PGE1组给药后TXA2下降幅度大于rhBNP组;rhBNP组cGMP升高幅度大于PGE1组.结论 rhBNP与PGE1在用药后均能有效降低肺动脉压,PGE1起效更快,效果更为显著.
目的 比較人重組腦鈉肽(rhBNP)與前列腺素E1(PGE1)對二尖瓣置換(MVR)術後肺動脈高壓的治療效果.方法 60例MVR術後平均肺動脈壓≥25 mmHg(1 mmHg=0.133 kPa)的患者,隨機分為對照組、PGE1組及rhBNP組,每組20例.3組分彆于用藥前、用藥後1、6、24 h以及停藥後2h鑑測患者的血流動力學參數,併記錄患者一般資料、術中情況及術後機械通氣時間;于用藥前、用藥後24 h、術後1週、3箇月檢測患者的外週靜脈血血栓素(TXA2)與環燐痠鳥苷(cGMP)水平.結果 PGE1組的機械通氣時間小于對照組和rhBNP組.PGE1組給藥後1h患者的平均動脈壓、平均肺動脈壓(mPAP)、肺循環血管阻力指數(PVRI)、肺血管楔嵌壓(PAWP)降低,停藥後上述指標反彈;rhBNP組給藥後6h齣現mPAP、PRVI、PAWP降低,mPAP下降幅度小于PGE1組.對照組術後TXA2下降,cGMP上升;PGE1組和rhBNP組給藥24h後TXA2下降和cGMP升高幅度均大于對照組.PGE1組給藥後TXA2下降幅度大于rhBNP組;rhBNP組cGMP升高幅度大于PGE1組.結論 rhBNP與PGE1在用藥後均能有效降低肺動脈壓,PGE1起效更快,效果更為顯著.
목적 비교인중조뇌납태(rhBNP)여전렬선소E1(PGE1)대이첨판치환(MVR)술후폐동맥고압적치료효과.방법 60례MVR술후평균폐동맥압≥25 mmHg(1 mmHg=0.133 kPa)적환자,수궤분위대조조、PGE1조급rhBNP조,매조20례.3조분별우용약전、용약후1、6、24 h이급정약후2h감측환자적혈류동역학삼수,병기록환자일반자료、술중정황급술후궤계통기시간;우용약전、용약후24 h、술후1주、3개월검측환자적외주정맥혈혈전소(TXA2)여배린산조감(cGMP)수평.결과 PGE1조적궤계통기시간소우대조조화rhBNP조.PGE1조급약후1h환자적평균동맥압、평균폐동맥압(mPAP)、폐순배혈관조력지수(PVRI)、폐혈관설감압(PAWP)강저,정약후상술지표반탄;rhBNP조급약후6h출현mPAP、PRVI、PAWP강저,mPAP하강폭도소우PGE1조.대조조술후TXA2하강,cGMP상승;PGE1조화rhBNP조급약24h후TXA2하강화cGMP승고폭도균대우대조조.PGE1조급약후TXA2하강폭도대우rhBNP조;rhBNP조cGMP승고폭도대우PGE1조.결론 rhBNP여PGE1재용약후균능유효강저폐동맥압,PGE1기효경쾌,효과경위현저.
Objective To investigate the effect of rhBNP in treating pulmonary hypertension after mitral value replacement (MVR) compared with PGE1.Methods 60 patients with pulmonary hypertension after MVR were randomly divided into 3 groups(control group, PGE1 group and rhBNP group).Hemodynamic factors(MAP, CVP, mPAP, etc.) were monitored before and after taking medicine at 1 h, 6 h, 24 h, respectively including drug withdrawal 2 h.TXA2 and cGMP were analyzed by ELISA.To observe the levels of TXA2 and cGMP in plasma before and after treatment with rhBNP and PGE1 for three times (24 h, 1 week and 3 months).Information about patients'mechanical ventilation time was also recorded.Results Patients' mechanical ventilation time in PGE1 group was the shortest.MAP, mPAP, PRVI, PAWP were reduced after treatment by medicine 1 h for in PGE1 group.However, these indexes were rebound after drug withdrawal.mPAP, PRVI, PAWP in rhBNP group decreased after treatment by medicine at 6 h.The decreased level of mPAP was less than that in PGEI group.In control group, TXA2 went down and cGMP went up after operation.After taking medicine at 24 h, TXA2 decreased and cGMP increased in both PGE1 and rhBNP group.The increased level in rhBNP group was higher than that of control group.With medicine, the decreased level of TXA2 in PGE1 was also higher than that in rhBNP group.The going-up of cGMP in rhBNP was higher than that in PGE1.Conclusion Both rhBNP and PGE1 can reduce pulmonary artery pressure, PGE1 is more effective than that of rhBNP.
