【心房利钠肽、脑利钠肽与心内直视手术围手术期心功能和肾功能的相关性】。

M Hata, O Masato, S Cho, M Narata, H Hata, T Inoue, Y Sezai
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引用次数: 0

摘要

心房钠肽(ANP)和脑钠肽(BNP)是人体心脏分泌的稳态激素,具有保护心脏和肾脏功能的作用。众所周知,这些激素在患者体内随着充血性心力衰竭或急性心肌梗死严重程度的增加而增加。然而,尚未见文献报道手术患者行体外循环(CPB)后ANP或BNP分泌水平的变化。我们评估了CPB致心力衰竭患者围手术期心功能和肾功能与ANP、BNP的关系。我们选择了45例择期心内直视手术患者。我们分别在术前、术后和术后3 d测量了45例患者的血浆ANP水平和18例患者的血浆BNP水平。同时测定心脏指数(CI)。这些病例被分为以下几组。A1组(n = 23):术前ANP < 40 pg/ ml。A2组(n = 22):术前ANP > 40 pg/ ml。B1组(n = 8):术前BNP升高至正常水平5倍的病例。B2组(n = 8):术前BNP升高至正常水平5倍的病例。B2组(n = 10):术前BNP大于正常值10倍的患者。我们分别对A1、A2组和B1、B2组围术期心肾功能进行比较研究。在术前心功能和肾功能方面,A1组和A2组之间无显著差异,CPB和术后CI期间尿量无显著差异。但CPB过程中,B1组的尿量明显多于B2组。此外,B1组术后CI发生率。此外,B1组术后CI发生率明显高于B2组。术前、术后第3天BNP水平与术后CI、术后第3天CI分别呈显著负相关(r = -0.641, -0.514, p = 0.008, 0.012)。由于手术和术后处理使心脏应激得到缓解,术后ANP和BNP水平趋于彼此大致相似的平均水平。根据这些结果和文献中的几个例子,术前高BNP被认为提示围手术期心脏和肾功能的潜在风险。我们认为,血浆BNP水平的测定有助于决定CPB血流的相关情况,并有助于采取措施加强术中心脏和肾脏的保护,因此对围手术期管理有重要的参考价值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[A correlation between atrial natriuretic peptide, brain natriuretic peptide, and perioperative cardiac and renal functions in open heart surgery].

Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are homeostatic hormones secreted from the human heart which protect both cardiac and the renal function. It is well known that these hormones increase in patients along with increases in the severity of congestive heart failure or acute myocardial infarction. However, as yet there are no reports in the literature on changes of the secreted level of ANP or BNP in surgical patients undergoing cardiopulmonary bypass (CPB). We evaluated the relationship between ANP, BNP, and perioperative cardiac and renal functions in patients with heart failure caused by CPB. We selected 45 patients of elective open heart surgery. We measured plasma level of ANP in all 45 cases, and BNP in 18 cases at preoperation, postoperation, and postoperatively three days after, respectively. At the same time, the cardiac index (CI) was measured. These cases were divided into the following groups. Group A1 (n = 23): cases in which the preoperative ANP was less than 40 pg/ ml. Group A2 (n = 22): cases in which the preoperative ANP was more than 40. Group B1 (n = 8): cases in which the preoperative BNP is increased to the level of 5 times as mach as the normal level. Group B2 (n = 8): cases in which the preoperative BNP is increased to the level of 5 times as much as the normal level. Group B2 (n = 10): cases in which the preoperative BNP was more than that of 10 times as mach as normal level. We then carried out a comparative study of the perioperative cardiac and renal functions in group A1 and A2, and group B1 and B2, respectively. In the terms of preoperative cardiac and renal function, there were no significant differences between groups A1 and A2, and there were no significant differences in urinary volume during CPB or post operative CI. However, the urinary volume during CPB of group B1 was significantly more than that of B2. Furthermore, the incidence of postoperative CI in group B1. Furthermore, the incidence of postoperative CI in group B1 was significantly higher than in B2. The preoperative and post operative third day BNP level had significant negative correlations with postoperative CI and postoperative third day CI, respectively (r = -0.641, -0.514, p = 0.008, 0.012). The postoperative ANP and BNP levels tend to a mean level roughly similar to one another because of the easing of cardiac stress by surgery and postoperative management. According to these results and several instances in the literature, a preoperative high BNP is considered to suggest a potential perioperative risk for cardiac and renal function. We conclude that determination of the plasma BNP level can be helpful for decisions related to CPB flow and measures taken to enhance cardiac and renal protection during surgery, and therefore is a useful reference for perioperative management.

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