血浆脑利钠肽在小儿室间隔缺损微创封堵术围术期的表达特征研究

Expression of plasma brain natriuretic peptide in children with ventricular septal defect treated by minimally invasive perventricular device closure during perioperative period

目的探讨血浆脑利钠肽(BNP)在小儿室间隔缺损(VSD)微创封堵围术期的变化及意义。方法纳入2015年1月-2017年1月于该科住院接受微创封堵术治疗的VSD患儿43例,分别于封堵术前、术后5 min、术后24 h采集患儿外周血标本,检测血浆BNP;分别于封堵术前、术后24 h开展超声心动图检查,测量并计算患儿左室舒张末期容量指数(LVEDVI)、左室舒张末期内经指数(LVEDDI)、左室射血分数(LVEF)。分析围术期上述指标的变化趋势,并分析各时点BNP与超声心动图指标的相关性。结果患儿术前BNP为(57.1±19.7)ng/ml,术后5 min上升至(112.5±22.8)ng/ml,术后24 h回落至(75.8±20.1)ng/ml,各时点两两对比,差异均有统计学意义(P<0.05)。患儿术后24 h时LVEDVI、LVEDDI均未出现明显变化(P>0.05),LVEF明显升高(P<0.05)。BNP与LVEDVI、LVEDDI均呈明显正相关(r=0.823,0.654;均P<0.001)。结论小儿VSD微创封堵术后近期BNP水平明显升高,提示介入封堵可能对心肌造成一过性损害。

Objective To explore the change and significance of plasma brain natriuretic peptide（ BNP） in children with ventricular septal defect（ VSD） treated by minimally invasive perventricular device closure during perioperative period. Methods From January 2015 to January 2017,43 children with VSD treated by minimally invasive perventricular device closure in Department of Cardiac Surgery,Gansu Provincial People＇s Hospital were selected,peripheral blood samples were obtained before the surgery,at 5 minutes and 24 hours after surgery,the levels of plasma BNP were detected. Echocardiography was performed before the surgery and at 24 hours after the surgery. Left ventricular end-diastolic volume index（ LVEDVI）,left ventricular end-diastolic diameter index（ LVEDDI）,and left ventricular ejection fraction（ LVEF） were measured and calculated. The change trends of above-mentioned indexes during perioperative period were analyzed,the correlations between BNP levels and indexes of echocardiography at different time points were analyzed. Results The level of BNP before surgery was（ 57. 1 ± 19. 7） ng/ml,which increased to（ 112. 5 ± 22. 8） ng/ml at five minutes after the surgery,then it decreased to（ 75. 8±20. 1） ng/ml,there were statistically significant differences among different time points（ P〈0. 05）. At 24 hours after the surgery,LVEDVI and LVEDDI didn＇t change significantly（ P〈0. 05）,while LVEF increased significantly（ P〈0. 05）. BNP was positively correlated with LVEDVI and LVEDDI（ r = 0. 823,0. 654,P〈0. 001）. Conclusion The level of BNP in the short term after minimally invasive perventricular device closure in the children with VSD increases significantly,which indicates that the surgery may lead to transient damage to myocardium.