经胸室间隔缺损封堵术围术期氨基末端脑钠肽前体的变化研究

Changes of N-terminal probrain natriuretic peptide during perioperative period of mini-invasive occlusion of ventricular septal defect

目的：探讨经胸微创室间隔缺损封堵术围术期氨基末端脑钠肽前体（NT-proBNP）的变化规律，从而客观地对微创封堵术心肌损伤的程度进行评估。方法2013年6月至2014年6月，我们选取符合条件的室间隔缺损患儿30例，采用经胸微创封堵术关闭室间隔缺损。分别于术前、术后1 h、2 h、6 h、12 h、24 h、48 h、7 d 共8个时间点，通过免疫定量分析仪，在床边快速测定血清 NT-proBNP 浓度，对比患儿术前及术后各时间点血清 NT-proBNP 的浓度变化趋势。结果所有病例拔管平均时间3．5±2．1 h，均治愈出院，平均住院时间7．1±1．5 d。封堵术后当时至术后6 h，NT-proBNP 无明显变化；至术后12～24 h，NT-proBNP 有升高，与各时间点比较均有统计学意义（P ＜0．05），术后48 h 逐渐下降至术前水平。结论经胸微创封堵术治疗室间隔缺损可致可逆性微小心肌损伤，术后床边快速检测 NT-proBNP，可早期识别和判断心肌损伤的程度，为临床防治术后并发症、促进患儿快速康复提供科学依据，方法简便，容易在临床推广应用，可作为筛查心肌损伤的手段。

Objetive To explore the effects of mini-invasive occlusion for ventricular septal defect （VSD）on N-terminal probrain natriuretic peptide （NT-proBNP）. Methods A total of 30 VSD children un-derwent mini -invasive occlusion.And serum NT-proBNP was detected by dry-type fluorescent quantitative an-alyzer at a total of 8 timepoints （i.e.baseline,1 h,2 h,6 h,12 h,24 h,48h ＆7 days post-operation）.The changes of serum NT-proBNP concentration were compared at each timepoint.Results All cases had a remov-al of intubation within a mean time of 3.5 ±2.1 h postoperation and a hospital discharge within a mean time of 7.1 ±1.5 d.NT-proBNP had no obvious change from finishing moment of operation to postoperative 6 h;NT-proBNP significantly increased untill 12 -24 h postoperatively.And their comparisons with other timepoints were statistically significant （P 〈0.05）;Then NT-proBNP gradually returned to preoperative levels. Conclu-sions Mini-invasive occlusion may cause reversible minor myocardial damage.Serum NT-proBNP may detect myocardial ischemia and anoxia early and provide scientific rationales for preventing and treating postoperative complications and promoting rapid recovery.Thus it may be used as a clinical screening tool for myocardial injury.