摘要
目的比较人重组脑钠肽(rhBNP)与前列腺素E1(PGE1)对二尖瓣置换(MVR)术后肺动脉高压的治疗效果。方法60例MVR术后平均肺动脉压≥25mmHg(1mmHg=0.133kPa)的患者,随机分为对照组、PGE1组及rhBNP组,每组20例。3组分别于用药前、用药后1、6、24h以及停药后2h监测患者的血流动力学参数,并记录患者一般资料、术中情况及术后机械通气时间;于用药前、用药后24h、术后1周、3个月检测患者的外周静脉血血栓素(TXA2)与环磷酸鸟苷(cGMP)水平。结果PGE1组的机械通气时间小于对照组和rhBNP组。PGE1组给药后1h患者的平均动脉压、平均肺动脉压(mPAP)、肺循环血管阻力指数(PVRI)、肺血管楔嵌压(PAWP)降低,停药后上述指标反弹;rhBNP组给药后6h出现mPAP、PRVI、PAWP降低,mPAP下降幅度小于PGE1组。对照组术后TXA2下降,cGMP上升;PGE1组和rhBNP组给药24h后TXA2下降和cGMP升高幅度均大于对照组。PGE1组给药后TXA2下降幅度大于rhBNP组;rhBNP组cGMP升高幅度大于PGE1组。结论rhBNP与PGE1在用药后均能有效降低肺动脉压,PGE1起效更快,效果更为显著。
Objective To investigate the effect of rhBNP in treating pulmonary hypertension after mitral value replacement (MVR) compared with PGE1. Methods 60 patients with pulmonary hypertension after MVR were randomly divided into 3 groups(control group, PGE1 group and rhBNP group). Hemodynamic factors( MAP, CVP, mPAP, etc. ) were monitored before and after taking medicine at 1 h, 6 h, 24 h, respectively including drug withdrawal 2 h. TXA2 and cGMP were analyzed by ELISA. To observe the levels of TXA2 and eGMP in plasma before and after treatment with rhBNP and PGE1 for three times (24 h, 1 week and 3 months). Information about patients" mechanical ventilation time was also recorded. Results Patients" mechanical ventilation time in PGE1 group was the shortest. MAP, mPAP, PRVI, PAWP were reduced after treatment by medicine 1 h for in PGE1 group. However, these indexes were rebound after drug withdrawal, mPAP, PRVI, PAWP in rhBNP group decreased after treatment by medicine at 6 h. The decreased level of mPAP was less than that in PGEI group. In control group, TXA2 went down and cGMP went up after operation. After taking medicine at 24 h, TXA2 decreased and cGMP in- creased in both PGE1 and rhBNP group. The increased level in rhBNP group was higher than that of control group. With medicine, the decreased level of TXA2 in PGE1 was also higher than that in rhBNP group. The going-up of cGMP in rhBNP was higher than that in PGE1. Conclusion Both rhBNP and PGE1 can reduce pulmonary artery pressure, PGE1 is more effective than that of rhBNP.
出处
《中华胸心血管外科杂志》
CSCD
2015年第10期600-603,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
天津市科技计划项目(08ZCKFSF03300)
关键词
二尖瓣
心脏瓣膜假体植入
肺动脉高压
重组脑利钠肽
前列腺素E1
Mitral valve Heart valve posthesis implantation Pulmonary hypertension Natriuretic peptidcs Prostaglandin E1