心脏手术前后Tei指数及脑钠肽变化的研究

Perioperative changes in Tei index and serum brain natriuretic peptide in patients undergoing cardiac surgery

目的探讨心脏瓣膜置换术前后Tei指数及心脏围手术期血清脑钠素(BNP)的变化规律及其意义。方法(1)对86例行主动脉瓣或二尖瓣置换术的患者,分别于术前1个月至1周、术后1周至1个月测量Tei指数;(2)对20例在非体外循环下行冠状动脉搭桥术的冠心病患者和30例在体外循环下行心脏瓣膜置换术的风心病患者,分别于术前、术后即刻、术后24h、3d和7d测量血清BNP浓度。结果(1)主动脉瓣狭窄、主动脉瓣关闭不全及二尖瓣狭窄患者术后Tei指数都有不同程度增加,自身手术前后相比差异有统计学意义(P<0.05或P<0.01),而二尖瓣关闭不全患者术后Tei指数降低,但手术前后差异无统计学意义(P>0.05);(2)冠心病和风心病患者术前血清BNP浓度均明显高于正常组(P<0.01),术后即刻与术前相似,此后迅速上升,24h达到高峰,然后开始下降,术后7d尚未降到术前水平;血清BNP浓度在体外循环和非体外循环下心脏手术中的变化相似,体外循环期间BNP没有进一步升高。结论心脏瓣膜置换术后Tei指数有明显变化,因此在评价瓣膜病患者的左心室功能时应考虑到瓣膜功能不全对Tei指数的影响;血清BNP浓度在体外循环和非体外循环下心脏手术中的变化相似,体外循环期间BNP没有进一步升高。

Objective This study was to investigate the changes of Tei index before and after surgical valve replacement and the perioperative changes of serum brain natriuretic peptide (BNP) concentrations in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) and off-pump. Methods (1)Participants consisted of 86 consecutive patients with aortic or mitral valve surgery .Tei indices were measured by transthoracic echocardiography in 1 week to 1 month before and after surgery; (2) 20 patients with CAD submitted to off-pump coronary artery bypass (OPCAB)and 30 patients with RHD submitted to cardiac valve replacement with CPB. BNP were measured at preoperation, immediately after operation, postoperatively 24 hours, 3 days and 7 days. Results (1)Tei index was significantly increased after surgery in patients with aortic stenosis, aortic regurgitation and mitral stenosis and the difference were significant (P< 0.01). Tei index was decreased in mitral regurgitation and had no significant difference (P>0.05); (2) The preoperative BNP was high, after surgery it was similar to the preoperative BNP level, it was elevated markedly and acutely to a peak value 24 hours after operation (P<0.01) and then was decreased after that; 7 days later, it was still higher than the concentration before operation (P<0.05). Changes in BNP concentrations following CPB and OPCAB were similar. Conclusions (1) Tei index significantly changed after valve surgery especially in patients with AS. We should evaluate the ventricular function in patients with valve disease and consider the effects of valve dysfunction on Tei index; (2)The preoperative serum BNP concentration is sensitive and specific in the diagnosis of preoperative cardiac function, and it is correlated significantly with NYHA cardiac function; the serum concentrations of BNP became markedly and acutely elevated after cardiac surgery, it was still high 7 days later and the changes of BNP in CPB and OPCAB were similar.