重组人脑钠肽对风湿性心脏瓣膜置换术后心肾功能的保护作用

The protective effect of recombinant human brain natriuretic peptide on heart and renal function after rheumatic heart valve replacement

目的探讨重组人脑钠肽对风湿性心脏瓣膜置换术后心肾功能的保护作用。方法选择2014年10月~2015年10月于沧州市中心医院接诊的70例需行风湿性心脏瓣膜置换术的患者进行研究，按随机数字法分为试验组和对照组各35例。两组均行气管插管静脉吸入的方式给予全身麻醉，术中对患者生命体征密切关注，对照组术后行多巴胺、肾上腺素、硝酸甘油进行静脉泵注，试验组在对照组的基础上加用重组人脑钠肽。观察两组患者术前及术后一周心、肾功能的变化情况，并随访1个月，观察不良事件。结果治疗后，试验组血浆氨基末端脑钠肽前体（NT-proBNP）低于对照组[（1072.54±245.81）ng/Lvs.（1384.52±391.77）ng/L，P＜0.01]，左室射血分数（LVEF）水平高于对照组[（53.81±6.28）%vs.（46.19±5.92）%，P＜0.01]；肾小球滤过率（eGFR）高于对照组[（75.18±17.31）ml/minvs.（62.71±15.62）ml/min，P＜0.01）]，尿素氮（BUN）低于对照组[（6.24±1.35）μmol/Lvs.（9.07±1.68）μmol/L，P＜0.01）]，血清肌酐（SCr）低于对照组[（116.74±24.40）μmol/Lvs.（129.56±25.76）μmol/L，P＜0.05）]，24h尿量高于对照组[（1650±235）mlvs.（1430±201）ml，P＜0.01）]。两组患者在不良事件发生率上差异无统计学意义（P＞0.05）。结论在风湿性心脏瓣膜置换术前使用重组人脑钠肽效果较好，可对患者心肾功能进行良好保护。

Objective To investigate protective effect of recombinant human brain natriuretic peptide onheart and renal function after rheumatic heart valve replacement. Methods 70 patients undergoing rheumatic heartvalve replacement from October 2014 to October 2015 in Cangzhou Central Hospital were divided into experimentalgroup (35 cases) and control group (35 cases) randomly. Intravenous-inhalational anesthesia was administered,and the vital signs of patients were paid close attention during the operation. After operation, control group wasadministered dopamine, epinephrine and intravenous infusion of nitroglycerin; the experimental group were treatedwith recombinant human brain natriuretic peptide on the basis of the control group. The changes of cardiac and renalfunction in two groups before and after operation were observed, and adverse events were observed during onemonthfollow-up. Results After treatment, N-terminal B-type natriuretic peptide (NT-proBNP) in experimentalgroup was lower than control group [(1072.54±245.81) ng/L vs. (1384.52±391.77)ng/L, P<0.01], the level ofLeft ventricular ejection fraction (LVEF) was higher in experimental group [(53.81±6.28)% vs. (46.19±5.92)%,P<0.01]; the level of glomerular filtration rate (GFR) higher in experimental group [(75.18±17.31)ml/min vs. (62.71±15.62)ml/min, P<0.01]; blood urea nitrogen (BUN) was lower in experimental group [(6.24±1.35)μmol/L vs.(9.07±1.68)μmol/L, P<0.01]; Serum creatinine (SCr) was lower in experimental group [(116.74±24.40)μmol/Lvs. (129.56±25.76)μmol/L, P<0.05]; 24 hours urine volume was higher in experimental group [(1650±235)ml vs.(1430±201)ml, P<0.01]. There was no statistically significant difference in the incidence of adverse events (P>0.05).Conclusion The use of recombinant human brain natriuretic peptide before rheumatic heart valve replacement isbetter, and can protect cardiac and renal function of patients.