儿童先天性心脏病手术前后血浆脑钠肽的变化

Changes of plasma brain natriuretic peptide in children with congenital heart disease before and after cardiac operation

目的研究先天性心脏病患儿手术前后血循环脑钠肽(Brain natriuretic peptide,BNP)的变化,了解不同类型先心病患儿手术对心功能的影响。方法以进行小儿先心病手术的100例患儿作为研究对象,选取同期体检健康儿童26例为对照组。先心病类型分为5个亚组[房间隔缺损组(n=14)、空间隔缺损组(n=63)、法络四联征组(n=10)、动脉导管未闭组(n=9)和肺动脉狭窄组(n=4)],术前1 d,术后1、2、7 d应用免疫荧光干式定量法测定BNP。结果先心病组术前BNP值与对照组相比差异有统计学意义(P<0.01),手术前患儿5组BNP值组间差异无统计学意义(P>0.05);5组先心病患儿术前BNP与术后4个时间点间比较差异有统计学意义(P<0.05)。先心病组各时间点两两比较,差异有统计学意义(P<0.01)。结论不同先心病类型的患儿之间心功能指标-血循环BNP没有差别,但比健康儿童升高。不同病理类型先心病,术后心功能变化不同。

Objective To observe dynamically the changes of blood circulating brain natriuretic peptide （BNP） before and after cardiac operation in children with congenital heart disease （CHD）, and to investigate the effect of repair surgery or deformity correction surgery on cardiac function of patients with CHD. Methods One hundred children who received cardiac operation were enrolled in the study as research subjects ,and 26 healthy children from outpatient clinic were served as controls. The patients with CHD were divided into 5 groups according to different types of CHD, atrial septal defect group （ n = 14）, ventricular septal defect group （ n ： 63 ）, Tetralogy of Fallot group （ n = 10）, patent ductus arteriosus group （ n = 9） ,pulmonary artery stenosis group （ n = 4）. The plasma levels of BNP were detected by immunofluorescence dry quantitative method at 1 day before operation and 1,2,7 days after operation. Results Before operation there were significant differences in the levels of BNP between CHD group and control group （ P 〈 0.05 ）, however, there were no significant differences in the levels of BNP among 5 CHD subgroups （ P 〉 0.05 ）. There were significant differences in the levels of BNP among the 4 time points before and after the operation （ P 〈 0.05）, and there were significant differences in the levels of BNP among the 4 time points between any two time points （ P 〈 0.05）. Conclusion There are no significant differences in the levels of blood circulating BNP among different types＇of congenital heart diseases, but the BNP levels are higher than those in healthy children. The changes of cardiac function are different in different pathological types of congenital heart diseases after operation.