重组人脑利钠肽用于伴有左心功能不全冠脉旁路移植术患者的临床研究

The investigation of recombinant human brain natrinretic peptide in patients with left ventricular dysfunction undergoing coronary artery bypass grafting with cardiopulmonary bypass

目的:观察围手术期应用重组人脑利钠肽对伴有左心功能不全冠脉旁路移植术患者的影响。方法:30例术前EF<50%行冠脉旁路移植术的患者随机分为两组,试验组15例围手术期在常规治疗基础上微泵注射rhBNP,对照组15例接受常规治疗。观察两组患者心脏自动复跳情况,IBP使用率,术后24 h CK-MB值,术后48 h血NT-proBNP,尿量,血肌酐水平及多巴胺用量;检测术后一周EF、左室收缩末期容积。结果:两组自动复跳率、IBP使用率、术后24h CK-MB值,差异无统计学意义(P>0.05)。试验组术后48 h尿量显著多于对照组,差异有统计学意义(P<0.05),血肌酐水平、多巴胺用量、NT-proBNP均低于对照组,差异有统计学意义(P<0.05)。试验组术后一周EF、左室收缩末期容积与对照组比较,差异有统计学意义(P<0.05)。结论:围手术期使用rhBNP有助于保护左心功能低下冠心病患者冠脉旁路移植术后的心、肾功能。

Objective To investigate the effects of recombinant human brain natriuretic peptide（ rhBNP） in patients with left ventricular dysfunction undergoing coronary artery bypass grafting. Method 30 patients with ejection fraction 50% who were undergoing coronary artery bypass grafting were randomly divided into two groups. 15 patients in control group were Perioperatively given conventional therapy and 15 patients in experimental group were intravenously given rhBNP. The spontaneous heart beat recovery 、CK-MB in blood plasma 24 hour after surgery、urine volume、serum creatinine、dopamine dosage and NT-proBNP 48 hour after surgery were recorded. Left ventricular end-systolic volume and ejection fraction were also measured one week after surgery. Results There were no significant differences of the spontaneous heart beat recovery 、CK-MB in blood plasma 24 hour after surgery and the usage of IBP between two groups（ P〉0. 05）. The urine volume was significantly higher in experimental group than in control group. The serum creatinine、dopamine dosage and NT-proBNP 48 hour after surgery were lower in experimental group than in control group（ P〈0. 05）. There were also significant differences of left ventricular end-systolic volume and ejection fraction one week after surgery between two groups（ P〈0. 05）. Conclusion Perioperative application of rhBNP can improve the heart and renal function of patients with left ventricular dysfunction undergoing coronary artery bypass grafting.