术前血浆肽素水平对心肺转流下发生血管舒张性休克的预测价值

Predictive value of preoperative plasma copeptin level for vasodilatory shock in patients under cardiopulmonary bypass

目的探讨术前血浆肽素水平对心肺转流(CPB)下行冠状动脉旁路移植术(CABG)发生血管舒张性休克(VS)的预测价值。方法择期CPB下行CABG患者42例,术中连续监测血流动力学变化,并据此分为VS组(12例)和C组(血压正常,30例)。比较两组术前左心室射血分数(EF)及手术前后的血浆精氨酸加压素和肽素水平。结果与C组相比,VS组术前EF及术后血浆精氨酸加压素浓度降低(P<0.05),术前血浆肽素浓度升高(P<0.05)。术前血浆肽素浓度为10.13pmol/L时,其预测VS的敏感度为92%,特异度为87%。结论术前血浆肽素水平对VS的发生具有良好的预测价值。

Objective To investigate the predictive value of preoperative plasma copeptin level for vasodilatory shock（VS） in patients undergoing coronary artery bypass grafting（CABG） under cardiopulmonary bypass （CPB）. Methods On the basis of hemodynamic changes, 42 patients undergoing CABG under CPB were divided into groups of VS（with VS, 12 cases） and C（without VS, 30 cases）. Preoperative left ventricular ejection fraction（EF） and perioperative plasma concentrations of copeptin and arginine vasopressin（AVP） were detected and compared between two groups. Results Compared with group C, preoperative EF and postoperative AVP plasma concentration were lower, while preoperative copeptin plasma concentration was higher, in group VS（P〈0. 05）. Taking plasma copeptin concentration of 10.13 pmol/L as a cut off value, the sensitivity and specificity for copeptin to predict VS were 92% and 87%,respectively. Conclusion Preoperative plasma copeptin level is a good predictor for VS in patients undergoing CABG under CPB.