重组人脑利钠肽对风湿性心脏病患者术后肺动脉压及肺动脉血流的动态影响

Dynamic effects of recombinant human brain natriuretic peptide on postoperative pulmonary artery pressure and pulmonary artery blood flow in patients with rheumatic heart disease

目的探讨重组人脑利钠肽对风湿性心脏病患者术后肺动脉压及肺动脉血流的动态影响。 方法选取2009年5月至2013年5月68例风湿性心脏病患者为研究对象，将患者随机分为观察组与对照组，每组34例。所有患者均行瓣膜置换术，术后对照组接受常规治疗，观察组在对照组的基础上另行重组人脑利钠肽干预。记录两组用药前15 min，用药后15 min、1 h、2 h、4 h血压（BP）、肺动脉压（PAP）、平均肺动脉压（MPAP）、肺毛细血管楔压（PAWP）、心脏指数（CI），全肺血管阻力（PVR）变化。 结果观察组用药后15 min、1 h、2 h、4 h PAWP、MPAP、PVR低于治疗前，CI高于治疗前，差异有统计学意义（P〈0.05）；对照组用药后15 min、1 h、2 h、4 h PAWP、MPAP、CI、PVR与治疗前比较差异未见统计学意义（P〉0.05）。观察组用药后15 min、1 h、2 h、4 h PAWP、MPAP、PVR均低于对照组，CI分别为（2.51±0.53）、（2.82±0.55）、（2.81±0.56）、（2.82±0.53）L/（min·m2），均高于对照组，差异有统计学意义（P〈0.05）。 结论风湿性心脏病患者术后使用重组人脑利钠肽对BP、PAP无明显影响，可有效降低PAWP、MPAP、PVR，并维持肺动脉血流平稳，CI升高，改善心脏灌注，增加心输出量。

Objective To study the dynamic effects of recombinant human brain natriuretic pep- tide on postoperative pulmonary artery pressure and pulmonary artery blood flow in patients with rheumatic heart disease. Methods From May 2009 to May 2013,68 patients with rheumatic heart disease were selected as study subjects and they were randomly divided into observation group and control group, with 34 cases in each group. All patients underwent valve replacement. After operation, the control group re- ceived routine treatment. On this basis, the observation group was additionally treated with recombinant human brain natriuretie peptide intervention. The changes of blood pressure （ BP）, pulmonary arterial pressure （PAP）, mean pulmonary artery pressure （MPAP）, pulmonary capillary wedge pressure （PAWP）, cardiac index （CI） and total pulmonary vascular resistance （PVR） at 15 min before medica- tion, 15 rain, 1 h, 2 h and 4 h after medication in the two groups were observed. Results In the obser- vation group, the levels of PAWP, MPAP and PVR at 15 min, 1 h, 2 h and 4 h after medication were lower than those before treatment, while the level of CI was higher than that before treatment （P 〈 0. 05）. There was no significant difference in PAWP, MPAP, CI or PVR in the control group before medication or at 15 min, 1 h, 2 h and 4 h after medication （P 〉0.05）. In the observation group, the levels of PAWP, MPAP and PVR at 15 min, 1 h, 2 h and 4 h after medication were lower than those in the control group, while the levels of CI [ （2. 51±0. 53）, （2. 82 ±0.55）, （2. 81±0. 56）, （2.82±0. 53 ） L/（ min/m^2 ） ] were higher than those in the control group （ P 〈 0. 05 ）. Conclusions Recombinant human brain natriuretie peptide has no significant effect on BP and PAP in patients with rheumatic heart disease. It can effectively reduce PAWP, MPAP and PVR, maintain stability of pulmonary artery blood flow, increase CI, improve the cardiac perfusion and the cardiac output.