先天性心脏病患儿血浆NT-proBNP和hs-CRP水平在麻醉风险评估的探讨

Plasma NT-proBNP and hs-CRP Levels in Children with Congenital Heart Disease

目的探讨先天性心脏病(CHD)患儿术前血浆N端B型脑钠肽前体(NT-proBNP)、超敏C反应蛋白(hs-CRP)水平应用于麻醉病情风险评估。方法随机选取广西中医药大学附属瑞康医院2012年6月—2014年6月收治的76例年龄2～12岁的左向右分流型CHD患儿,采用美国麻醉医师协会(ASA)病情分级进行麻醉前病情评估,并于麻醉前检测血浆NT-proBNP和hs-CRP浓度,与同期46名健康体检儿童为对照。结果左向右分流型CHD患儿组中,麻醉前血浆NT-proBNP浓度为(2.834±0.159)pg/mL,高于对照组的(2.401±0.159)pg/mL(t=14.578,P=0.001),与其ASA分级呈正相关(r=0.835,P=0.000);麻醉前血浆hs-CRP浓度为(11.78±3.09)pg/mL,高于对照组的(5.42±1.60)pg/mL(t=12.935,P=0.001),与其ASA分级呈正相关(r=0.665,P=0.000)。结论左向右分流型CHD患儿麻醉前NT-proBNP、hsCRP水平与麻醉ASA评估分级有一定相关性,对CHD患儿麻醉前病情风险评估有一定的指导意义。

Objective To investigate the preoperative plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) levels in children with congenital heart disease (CHD). Methods 76 children aged 2 to 12 years old with left-to-right shunt type CHD were randomly selected from Ruikang Hospital affiliated to Guangxi University of Traditional Chinese Medicine from June 2012 to June 2014. The American Society of Anesthesiologists (ASA) was used to classify the disease. Pre-anesthesia assessment was performed and plasma NT-proBNP and hs-CRP concentrations were measured before anesthesia, compared with 46 healthy children in the same period. Results In the left-to-right shunt CHD group, the plasma NT-proBNP concentration before anesthesia was (2.834±0.159)pg/mL, which was higher than that of the control group (2.401±0.159)pg/mL (t=14.578, P=0.001), positively correlated with its ASA grade (r=0.835,P=0.000);plasma hs-CRP concentration before anesthesia was (11.78±3.09)pg/mL, higher than that of the control group (5.42±1.60)pg/mL (t=12.935, P=0.001), positively correlated with its ASA classification (r=0.665,P=0.000). Conclusion The levels of NT-proBNP and hs-CRP in children with left-to-right shunt type CHD have a certain correlation with the evaluation of anesthesia ASA. It has certain guiding significance for the assessment of the risk of pre-anesthesia in children with CHD.