房间隔缺损患者围手术期血浆脑钠肽(BNP)与平均肺动脉压(mPAP)的关系

The Relationship of Serum Brain Natriuretic Peptide (BNP) and Mean Pulmonary Arterial Pressure (mPAP) in Patients with Atrial Septal Defects

目的观察心外科三种不同方法治疗房间隔缺损,手术前后血浆脑钠肽(brain natriuretic peptide,BNP)变化,分析其与心功能变化的关系。方法选择2015年1月至2017年6月在我院治疗的房间隔缺损28例,其中体外循环下房间隔缺损补片修补8例,经右胸小切口封堵12例,经颈静脉封堵8例。平均年龄(17.9±12.2)岁,平均体质量(44.6±24.8)kg。分别于封堵当天术前及术后24 h、术后3个月抽血检测BNP浓度。术前、术后24 h和术后3个月经胸心脏超声检查肺动脉压变化。结果补片修补组术前、术后24 h和术后3个月的mPAP分别为(36.2±6.1)mm Hg,(35.8±5.3)mm Hg和(28.8±4.2)mm Hg,血浆BNP浓度分别为(175.2±58.3)pg/ml,(556.5±191.6)pg/ml和(169.0±43.4)pg/ml;经胸封堵组mPAP分别为(23.8±4.8)mm Hg,(22.3±3.9)mm Hg和(22.6±4.5)mm Hg,血浆BNP浓度检测分别为(138.5±63.2)pg/ml,(404.6±188.5)pg/ml和(113.0±41.4)pg/ml;经颈静脉封堵组mPAP分别为(21.3±5.2)mm Hg,(18.8±3.6)mm Hg和(17.9±2.7)mm Hg,血浆BNP浓度检测分别为(102.5±78.5)pg/ml,(392.8±263.1)pg/ml,(78.6±35.4)pg/ml。从总体上讲,手术后各组mPAP逐渐下降,BNP短暂升高后明显下降(P<0.05);BNP与mPAP之间有相关性(P<0.05)。结论在采用3种不同方法进行治疗的房间隔缺损患者中,mPAP与BNP之间存在明显的相关性。选择合适的手术方法,对心功能及mPAP的恢复具有明显的临床意义。

Objective To analyze the relationship of serum brain natriuretic peptide（ BNP） and mean pulmonary arterial pressure（ mPAP） in three different methods of atrial septal defect procedures. Methods From January,2015 to June,2017,28 cases of atrial septal defects were treated in our hospital. In this study,there were 8 cases repaired with heterologous pericardium patch under CPB（ group A）,12 cases were blocked by transthoracic minimal invasive occlusion surgery（ group B）,and 8 cases blocked by percutaneous trans-jugular vein occlusion surgery（ group C）. The patients were（ 17. 9 ± 12. 2） years old with body mass of（ 44. 6 ±24. 8） kg. The BNP concentration was detected on the day before operation,24 hours after operation,and 3 months after surgery. The mPAP changes were measured as well. Results In group A,it was detected mPAP of（ 36. 2 ± 6. 1） mm Hg,（ 35. 8 ± 5. 3） mm Hg and（ 28. 8 ± 4. 2） mm Hg respectively pre-operatively,24 hours post-operatively and 3 months post-operatively. And the BNP was（ 175. 2 ± 58. 3） pg/ml,（ 556. 5 ±191. 6） pg/ml and（ 169. 0 ± 43. 4） pg/ml. In group B,the mPAP was（ 23. 8 ± 4. 8） mm Hg,（ 22. 3 ± 3. 9） mm Hg and（ 22. 6 ± 4. 5） mm Hg respectively,and BNP was（ 138. 5 ± 63. 2） pg/ml,（ 404. 6 ± 188. 5） pg/ml and（ 113. 0 ± 41. 4） pg/ml. In group C,the mPAP was（ 21. 3 ± 5. 2） mm Hg,（ 18. 8 ± 3. 6） mm Hg and（ 17. 9 ±2. 7） mm Hg,and BNP concentrations was（ 102. 5 ± 78. 5） pg/ml,（ 392. 8 ± 263. 1） pg/ml and（ 78. 6± 35. 4） pg/ml respectively. It had significant co-relationship between the BNP and mPAP according to the correlation coefficient analysis（ P〈0. 05）. Conclusion In all the 3 groups,it shows significant co-relationships between the BNP concentration and the mPAP.