术前B型脑钠肽预测体外循环冠状动脉旁路移植术后并发症的作用

Prediction function of preoperative B-type natriuretic peptide in patients to receive on-pump coronary artery bypass grafting with postoperative complications

目的：探讨B型脑钠肽（brain natriuretic peptide,BNP）预测体外循环冠状动脉旁路移植术（coronary artery bypass grafting,CABG）后并发症的作用。方法 ：选择2013年1月至2014年11月在体外循环下行CABG术的132例患者纳入本研究。其中男78例,女54例;年龄35~82（63±11.35）岁。于围手术期不同时段测定BNP,比较不同左室射血分数（left ventricular ejection fraction,LVEF）患者的BNP变化差异。分析BNP与术后一系列不良事件的相关性。采用受试者工作特征（receiver operating characteristic,ROC）曲线分析BNP对术后并发症的预测作用。结果：LVEF〈45%患者的BNP在术前及术后各时段均明显高于LVEF≥45%患者（P〈0.05）。术前BNP与术前LVEF呈负相关（r=-0.512,P〈0.05）,与术后一系列不良事件呈正相关（r=0.254~0.602,P〈0.05）。BNP预测术后新发心房颤动的ROC曲线下面积为0.780,预测使用IABP的ROC曲线下面积为0.893,预测术后急性肾功能不全的ROC曲线下面积为0.818,预测术后ICU停留超48 h或28 d内死亡的ROC曲线下面积为0.820。结论：BNP水平能准确反映冠状动脉旁路移植术前患者的心功能状态,与术后并发症密切相关,并可做出良好的预测。

Objective To investigate the prediction function of preoperative B-type natriuretic peptide in patients to receive on-pump coronary artery bypass grafting with postoperative complications. Methods One hundred and thirty-two patients, including 78 males and 54 females, received on-pump coronary artery bypass grafting from January 2013 to November 2014 and were enrolled in the study. The patients were（63 ± 11.35） years old（ range from 35 to 82 years）. The level of BNP was determined before operation, after operation, and on day 1, 2, 3 and 7 post-operation. Relationships were analyzed between BNP and LVEF,ventilation time, length of stay in ICU, the need for inotropic agents or intra-aortic balloon pump（IABP）, incidence of postoperative atrial fibrillation, and acute renal failure. Receiver operating characteristic（ROC） curve analysis was also performed to predict the role of BNP in postoperative complications. Result A negative correlation between preoperative BNP level and preoperative LVEF（r =-0.512,P〈0.05） was found. The preoperative BNP level was positively correlated with a series of adverse events. The preoperative BNP was used to predict incidence of postoperative atrial fibrillation, the possibility of using IABP, renal failure, length of stay in ICU exceeding 48 h or mortality at 28 days, and the area under the ROC curve（AUC） was 0.780, 0.893, 0.818 and 0.820,respectively. Conclusion The preoperative BNP level is well correlated with the cardiac function before CABG,which may be a good predictor of postoperative complications after CABG.