室上性心动过速患者心钠素的浓度变化及其与血流动力学变化的关系

The Changes of Concentration of Atrial Natriuretic Peptide and Haemodynamic Correlates in Patients With Supraventricular Tachycardias

探讨室上性心动过速 (SVT)患者心钠素 (ANP)的浓度变化及其与心房压、股动脉压变化的关系。选择房室折返性心动过速 (AVRT)组 2 3例及房室结折返性心动过速 (AVNRT)组 17例。在心内电生理检查中 ,所有患者在诱发SVT前取冠状窦、右心房、股动脉和股静脉血各 3ml,测定ANP ,并测右心房峰值压、股动脉压。诱发SVT 5min后重复上述检查。记录心率并终止SVT。结果 :①两组SVT时各部位ANP浓度较发作前增加 (P均 <0 .0 0 1) ,AVNRT组增加更为明显 ;②两组SVT时右心房峰值压与各部位ANP浓度呈高度正相关 (P均 <0 .0 1)。③SVT时两组病例股动脉收缩压均有显著下降 (P <0 .0 0 1) ,但差别无显著性 (P >0 .0 5 ) ;其下降与ANP浓度呈高度负相关 (P均 <0 .0 1)。结论 :SVT发作能使患者循环系统各部位ANP浓度明显增加 ,但增加的程度不同 ,其主要原因是这两型SVT发作后右心房峰值压增加值的不同 ;两型SVT的股动脉收缩压的下降与ANP浓度升高有关。

To investigate the changes of concentration of atrial natriuretic peptide(ANP) and haemodynamic correlates in patients with supraventricular tachycardias.Forty patients were divided into atrioventricular nodal reentrant tachycardias (AVNRT) group (n=17) and atrioventricular reentrant tachycardias (AVRT) group(n=23). The levels of ANP in femoral artery(FA) , femoral vein(FV), right atria(RA) ,and coronary sinus(CS) with the peak right atrial pressure( peak RAP), and FA pressure were measured before and 5 min after onset of tachycardia. Results:During tachycardias, the plasma levels of ANP significantly increased both in AVNRT and AVRT groups (P< 0.001). The values of ANP levels in the AVNRT group after 5 min onset of tachycardia had more significant increases than those of the AVRT group(P<0.05). Before and 5 min after onset of tachycardia the peak RAP of each group had a marked increase(P< 0.001). After onset of tachycardia the higher values of peak RAP in AVNRT groups had more significant increases than those of the AVRT group(P< 0.01). Following tachycardia, significant correlations were found between the changes in plasma levels of ANP and peak RAP or amount of increase values( P<0.01). There was a marked fall in FA pressure in both groups at the onset of tachycardias(P<0.001). There were significant correlations among the plasma levels of ANP , the change in peak RAP, and the fall of blood press(BP)(P<0.001). Conclusion: During onset of tachycardias of AVNRT and AVRT , the plasma levels of ANP significantly increased. This study demonstrates that the release of ANP during tachycardia(both AVRT and AVNRT) is primarily dependent on increased atrial pressure. The ANP levels in patients with AVNRT have also more significant increases than those of patients with AVRT . The different plasma levels of ANP between AVRT and AVNRT are mainly caused by the change in value of peak RAP. There are significant negative correlations between the plasma levels of ANP and the fall of BP.