先心病肺动脉高压手术前后血浆心钠素变化

Pre and Post Operative Changes of Atrial Natriuretic Factor in Congenital Heart Disease with Pulmonary Hypertension

为了解先心病肺动脉高压手术前后血浆心钠素（ＡＮＦ）的变化，采用放免法测定３０例正常人和４６例先心病病人（含肺动脉高压２０例）血浆心钠素。结果示肺动脉高压病人术前、后ＡＮＦ水平显著高于正常组（Ｐ＜０．００１）；术前ＡＮＦ水平与Ｑｐ／Ｑｓ高度相关（ｒ＝０．９１，Ｐ＜０．００１），术后ＡＮＦ较术前明显降低（Ｐ＜０．０５）。动态监测血浆ＡＮＦ示术后２４小时处于低水平期，２４小时后轻度上升，与肺动脉收缩压变化平行。作者认为Ｑｐ／Ｑｓ升高是刺激ＡＮＦ分泌增加的一个重要因素。

This paper is to investigate the pre and post operative changes of the atrial natriuretic factor in patients with congenital intracardiac defect and pulmonary hypertension.Plasma atrial natriuretic factor (ANF) was measured by radioimmunoassay in 30 normal subjects and 46 patients with congenital intracardiac defects (20 with pulmonary hypertension).The results showed that the pre-and post-operative plasma ANF concentrations in patients with pulmonary hypertension were significantly higher than those with normal pulmonary arterial pressure (p<0.001).The preoperative ANF levels were extremely correlated with Qp/Qs(r=0.90,p<0.001).Dynamic monitoring of plasma ANF showed a very marked decrease of its concentration (p<0.001) together with very obvious drop of pulmonary arterial systolic pressure(PASP)(p<0.001) postoperativly as compared with the respective preoperative values.After the first 24 postoperative hours,the plasma ANF came down to a low level but not in parallel to changes of PASP.However,24 hours after weaning from the mechanical ventilation,a parallelism appeared between the rise in ANF and PASP.Authors beleive that increase of Qp/Qs ratio reflects the increase of pulmonary blood flow which is one of the important factors stimulating ANF secretion in patients with pulmonary hypertension.