摘要
目的观察氨基末端B型脑钠肽（Nt-proBNP）和大内皮素（bigET）在冠状动脉旁路移植术（CABG）前后的变化及其对术后近期并发症的预测价值。方法分析47例常规体外循环冠状动脉旁路移植术（CCABG）和43例非体外循环冠状动脉旁路移植术（OPCAB）患者术前和术后24hNt-proBNP、bigET水平变化,及其对术后近期并发症的预测因子。结果1术后24hCCABG和OPCAB两组Nt-proBNP和bigET均明显升高,CCABG组Nt-proBNP由术前（1083.5±717.9）pmol/L升到术后24h（1579.2±719.7）pmol/L（t=-4.30,P〈0.01）,bigET由术前（1.10±1.82）pmol/L升到术后24h（1.68±1.73）pmol/L（t=-5.35,P〈0.01）;OPCAB组Nt-proBNP由术前（999.6±843.6）pmol/L升到术后24h（1460.8±830.0）pmol/L（t=-4.20,P〈0.01）,bigET由术前（1.35±1.65）pmol/L升到术后24h（1.73±1.50）pmol/L（t=-2.46,P=0.018）。2术前Nt-proBNP水平与左室射血分数（LVEF）呈负相关（r=-0.43,P〈0.001）。3经单变量和多变量Logistic回归分析,LVEF相对比值比（OR）=1.045,95%可信区间（CI）为0.999~1.092,P=0.050、术后24h Nt-proBNP（OR=0.990,95%CI为0.999-1.000,P=0.014）水平是术后心力衰竭、低心排、围手术期心肌梗死、死亡、脑梗死的独立预测因子。经受试者工作特征曲线（ROC）分析术后24h Nt-proBNP〉1174.41pmol/L时,曲线下面积为0.698,95%CI为0.585-0.811,P〈0.003,敏感性为88.9%,特异性为57.1%,可预测近期并发症。结论CABG术后Nt-proBNP、bigET明显升高;LVEF、术后24h Nt-proBNP水平可预测术后近期并发症的发生。
Objective To examine the change in N-terminal pro-brain natriuretic peptide （Nt-proBNP） and big endothelin （bigET） in patients undergoing coronary artery bypass grafting （CABG）, and to evaluate their value in predicting postoperative mortality and complication. Methods Forty-seven patients undergoing coronary artery bypass grafting under on-pump（CCABG） and 43 patients undergoing off-pump bypass（OPCAB） were included for study. The levels of Nt-proBNP and bigET were determined before and 24 hours after operation in all patients. Results ①There were no differences between two groups. The serum levels of Nt-proBNP and bigET increased significantly 24 hours after operation. Compared with those before operation, Nt-proBNP （1 083.5±717.9）pmol/L in CCABG group was increased （1 579.2±719.7）pmol/L, t=-4.30, P〈0.01, bigET was increased from （1.10±1.82 ） pmol/L to （1.68±1.73） pmol/L （t=-5.35, P〈0.01） 24 hours after operation; Nt-proBNP （999.6±843.6） pmol/L in OPCAB group was increased （1 460.8±830.0） pmol/L, t=-4.20, P〈0.01, bigET was increased from （1.35±1.65） pmol/L to （1.73±1.50） pmol/L （t=-2.46, P=0.018） 24 hours after operation. ②The level of Nt-proBNP before operation was showed to be negatively correlated with left ventricular ejection fraction （LVEF） （r=-0.43, P〈0.001）. ③By univariate and multivariate Logistic regression analysis, the association of clinical variable with postoperative complication was assessed. Multivariable predictors,including the level of LVEF （OR=1.045, 95%CI：0.999-1.092, P=0.050） and Nt-proBNP 24 hours after operation （OR=0.990, 95%CI：0.999-1.000,P=0.014）, were significantly associated with a higher postoperative mortality, lower cardiac output, and higher incidence of myocardial infarction and congestive heart failure. Receiver operating characteristic curves （ROC） for Nt-proBNP 24 hours after operation was valid for the prediction of postoperative complication, and the area under the curve was 0.698 （95%CI：0.585-0.811, P〈0.003）, sensitivity and specificity were 88.9% and 57.1%, respectively. Conclusion Significant increase in Nt-proBNP and ET is found after CABG. BNP and LVEF are showed to be risk factors for postoperative complications in patients undergoing CABG.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2007年第11期667-670,共4页
Chinese Critical Care Medicine
关键词
冠状动脉旁路移植术
氨基末端B型脑钠肽
大内皮素
coronary artery bypass grafting
N-terminal pro-brain natriuretic peptide
big endothelin
