摘要
目的:观察二尖瓣置换患者围手术期脑钠尿肽(brain natriuretic peptide,BNP)、N末端脑尿钠肽原(N-termi-nal proBNP,NT-proBNP)及其比值(NT-proBNP/BNP)的变化规律,并探讨其临床意义。方法:25例二尖瓣狭窄(MS)组的患者和20例二尖瓣关闭不全(MR)组患者,术前按NYHA标准进行心功能标准分级,分别于术前1 d、术后1周、2周、3周、4周测血浆BNP、NT-proBNP浓度,同时予以超声心动图检查,测量左室射血分数(LVEF)、左房内径(LAD)、左室舒张末内径(LVEDD),分析术前BNP、NT-proBNP、NT-proBNP/BNP浓度与NYHA心功能分级、LVEF、LAD、LVEDD等的关系,并比较它们在MR组与MS组围手术期的变化及其与术后并发症的关系。结果:①MS组患者术前BNP、NT-proBNP与NYHA、LVEDD均呈正相关(P<0.05),与LVEF、LAD无相关性,且BNP与NYHA、LVEDD的相关性较NT-proBNP、NT-proBNP/BNP更为密切;②术后出现房颤并发症的患者术前BNP、NT-proBNP高于未出现房颤患者,且随着房颤转复而降低;术后出现肾功能不全的患者其术前NT-proBNP比未出现肾功能不全的患者高,且随着肾功能的恢复而降低,;而NT-proBNP/BNP无此种变化;③术前MR组LVEDD、BNP、NT-proBNP均大于MS组,且随着LVEDD变化,BNP、NT-proBNP在两组间变得无显著差异,而NT-proBNP/BNP于术前两组间无统计学意义;④二尖瓣患者围手术期BNP、NT-proBNP呈先升高后降低的变化趋势,且BNP、NT-proBNP、LVEDD变化趋势大致一致,主要发生在术后1、2、3周,而NT-proBNP/BNP的变化与BNP、NT-proBNP及LVEDD未发现明显规律性的联系。结论:BNP可以反映LVEDD的变化,可作为二尖瓣病变患者术前心功能评估的参考指标,而NT-proBNP/BNP临床应用价值不大。
AIM：To investigate the clinical significance and changes of brain natriuretic peptide （BNP）, NT-proBNP and NT-proBNP/BNP during the perioperative period in patients with mitral valve replacement. METHODS： The study enrolled 25 patients with mitral valve stenosis （MS） and 20 patients with mitral valve regurgitation （MR）. The concentrations of plasma BNP NT-proBNP and NT-proBNP/BNP were measured 1 day prior to cardiac surgery and during the first, second, third and fourth weeks after cardiac surgery. At the same time, left ventricular ejection fraction （LVEF）, left atrial diameter （LAD）, and left ventricular end-diastolic diameter （LVEDD） were measured by echocardiogram. The changes of observation indicators during the perioperative period were analyzed. RESULTS： Before surgery, BNP and NT-proBNP were correlated positively with NYHA and LVEDD （P〈0.05） but not correlated with LVEF and LAD. BNP correlated more with NYHA and LVEDD than with NT-proBNP and NT-proBNP/BNP. Before surgery, levels of BNP and NT-proBNP in patients with atial fibrillation （AF） after surgery was higher than those in patients without AF and decreased with AF converting to normal. The changes of the levels of NT-proBNP in patients with renal dysfunction after surgery were similar to those in patients with atial fibrillation, but no such difference was observed in NT-proBNP/BNP. Before surgery, LVEDD, BNP and NT-proBNP in the MR group were higher than those in the MS group but, with the changes of LVEDD, the difference in BNP and NT-proBNP became insignificant between groups. No difference was observed in NT-proBNP/BNP between groups before surgery. BNP and NT-proBNP in patients with mitral valve replacement increased in the early perioperative period and decreased in the late phase. The main changes of BNP, NT-proBNP and LVED occurred during the first 3 weeks after operation and no obvious relationship was found between the changes of NT-proBNP/BNP and the changes of BNP, NT-proBNP and LVEDD. CONCLUSION： The level of BNP can reflect the changes of LVEDD and can be used as a reference index for cardiac function before surgery, but NT-proBNP/BNP is of no great clinical value. The differences of BNP and NT-proBNP between the MR group and MS group may mainly relate to the size of the LVEDD. Monitoring BNP, NT-proBNP and LVEDD in patients with mitral valve replacement has some positive clinical significance perioperatively.
出处
《心脏杂志》
CAS
2011年第5期650-654,共5页
Chinese Heart Journal
关键词
二尖瓣置换
脑尿钠肽
N末端脑尿钠肽原
心功能
mitral valve replacement
brain natriuretic peptide
N-terminal proBNP
cardic function
