小儿法洛四联症根治术后氨基末端脑钠肽前体水平变化及其临床意义分析

Analysis of the Change and its Clinical Significance of N-terminal Pro-Brain Natriuretic Peptide Level in Children with Tetralogy of Fallot after Radical Operation

目的：探讨小儿法洛四联症根治术后血浆氨基末端脑钠肽前体（N—terminal pro-brain natriuretic peptide，NT-proBNP）水平变化及其临床意义。方法：选择我院2011年10月～2013年4月收治的法洛四联症患儿52例，所有患儿行法洛四联症根治术治疗，并于术前、术后3h、12h、48h、1周、1个月和3个月测定患儿血浆NT-proBNP水平，应用心脏彩超机检查肺动脉跨瓣压差、右室舒张末期容积（rightventricularend．diastolicvolume，RVEDV）、左室射血分数（Leftventricular ejection fraction，LVEF）和右心Tei指数（Teiindex）。结果：①术后3hNT—proBNP水平开始逐渐升高，术后48h达最高，明显高于术前水平（P〈0．01），术后1个月、3个月明显低于治疗前水平（P〈0．05）。②术后1周，右心功能不全组血浆NT．proBNP水平、肺动脉跨瓣压差、RVEDV明显高于右心功能正常组，LVEF明显低于右心功能正常组（P〈0．05）。③术后3个月，重度返流组、中度返流组患儿术后48h、1周、3个月血浆NT—proBNP明显高于轻度返流组（P〈0．05）；重度返流组患儿术后1周、3个月血浆NT—proBNP明显高于轻度返流组（P〈0．05）。结论：NT．proBNP在小儿法洛四联症根治术后早期的变化水平与右心功能的变化一致，可以作为评估右心功能的客观指标。

Objective： To explore the change and its clinical significance of N-terminal pro-brain natriuretic peptide level in children with tetralogy of Fallot after radical operation. Methods： 52 cases of tetralogy of Fallot were selected in our hospital from October 2011 to April 2013, all patients underwent radical operation, and detected plasma NT-proBNP preoperative, postoperative 3h, 12h, 48h, 1 week, 1 month and 3 months, Meanwhile, fight ventricular end-diastolic volume （RVEDV）, pulmonary artery pressure differences left ventricular ejection fraction （LVEF） and right ventricular Tei index were detected by cardiac ultrasound. Results： @The NT-proBNP level gradually increased in postoperative 3h, after 48h, reached the highest level, significantly higher than the preoperative level （P〈0.01）, 1 months, 3 months after operation was obviously lower than that of before treatment （P〈0.05）. @ 1 week after operation, the levels of plasma NT-proBNP, pulmonary artery pressure gradient across the valve and the RVEDV in right heart dysfunction group was significantly higher than that of right ventricular function in normal group, LEVF was significantly lower than that of right ventricular fi.mction in normal group （P〈0.05）. @3 months postoperatively, severe reflux group, moderate regurgitation patients received 48h, 1 weeks, 3 months, plasma NT-proBNP was significantly higher than the mild reflux group （P〈0.05）; severe reflux group after 1 weeks, 3 months, plasma NT-proBNP was significantly higher than the mild reflux group （P〈0.05）. Conclusion： The change of NT-proBNP early in the radical operation of tetralogy of Fallot after levels and fight heart function, can be used as objective indicators of right heart function evaluation.