摘要
目的探讨B型脑钠肽(BNP)在非体外循环冠状动脉旁路移植术(OPCAB)围术期的变化规律,及其对使用主动脉内球囊反搏(IABP)、术后心房颤动、拔除气管内插管时间和住ICU时间的影响。方法回顾性分析2009年9月至2010年3月北京安贞医院连续168例冠心病患者行OPCAB的临床资料,其中男133例,女35例;年龄60.77±9.32岁。于术前、术后即刻、术后第1 d、第2 d和第3 d测定BNP,记录并分析BNP与使用IABP、预后、拔除气管内插管时间和住ICU时间的关系。结果住院死亡2例,分别死于低心排血量综合征、感染和循环衰竭。BNP于手术后即刻开始显著升高,术后第1 d达高峰,然后逐渐下降。术前和术后LVEF<50%患者的BNP均明显高于LVEF≥50%患者(术后第2 d中位数:2 198.20 pg/ml vs.531.65 pg/ml,P<0.05);使用IABP患者BNP术前、术后均明显高于未使用IABP患者(术后第1 d中位数:5 066.75 pg/ml vs.745.20 pg/ml,P<0.05),术前BNP预测放置IABP的ROC曲线下面积为0.834;术后有心房颤动患者BNP均明显高于无心房颤动患者(术后第1 d中位数:1 070.60 pg/ml vs.747.80 pg/ml,P<0.05)。术后BNP与使用IABP(术后第3 d:r=0.437,P<0.05)、预后(术后第1 d:r=0.224,P<0.05)、拔除气管内插管时间(术后第3 d:r=0.440,P<0.05)和住ICU时间(术后第3 d:r=0.477,P<0.05)均呈正相关。结论 BNP是反映心功能不全的辅助指标之一,术前BNP显著升高是放置IABP、住ICU时间≥3 d的危险因子。
Objective To investigate the change characteristics of brain natriuretic peptide（BNP） after off-pump coronary artery bypass grafting（OPCAB）,and observe the relationship of BNP with atrial fibrillation,intensive care unit（ICU） stay time,time of withdrawing trachea tube,and usage of intraaortic balloon pump（IABP）.Methods We retrospectively analyzed the clinical data of 168 consecutive patients with coronary artery diseases who underwent OPCAB in Beijing Anzhen Hospital from September 2009 to March 2010.There were 133 males and 35 females with an age of 60.77±9.32 years.BNP was determined before operation,on the operative day just after operation,and day 1,2 and 3 after operation.At the same time,the relationship between BNP and ICU stay time,time of withdrawing trachea tube,occurrence of atrial fibrillation,and usage of IABP were also recorded.Results There were two in-hospital deaths,due to low cardiac output syndrome,infection and circulatory failure respectively.BNP increased significantly after operation with the peak level occurring 1 day after operation,after which it decreased gradually.BNP level in patients with their left ventricular ejection fraction（LVEF） under 50% was significantly higher than that in patients with LVEF equal to or above 50% before and after operation（the median BNP level at the second postoperative day： 2 198.20 pg/ml vs.531.65 pg/ml,P0.05）.BNP in patients using IABP was significantly higher than that in patients without using IABP before and after operation（the median BNP level at the first postoperative day： 5 066.75 pg/ml vs.745.20 pg/ml,P0.05）.The ROC value was 0.834 when perioperative BNP was used to predict the possibility of using IABP.BNP in patients with postoperative atrial fibrillation was also significantly higher than that in patients without atrial fibrillation（the median BNP level at the first postoperative day： 1 070.60 pg/ml vs.747.80 pg/ml,P0.05）.BNP was positively correlated with using IABP（at the third postoperative day： r=0.437,P0.05）,prognosis（at the first postoperative day： r=0.224,P0.05）,time of withdrawing trachea tube（at the third postoperative day： r=0.440,P0.05）,ICU stay time（at the third postoperative day： r=0.477,P0.05）.Conclusion BNP can be considered as one of the diagnostic criteria for ventricular dysfunction,and preoperative high BNP level is a risk factor for using IABP and ICU stay time equal to or longer than 3 days.
出处
《中国胸心血管外科临床杂志》
CAS
2011年第4期309-312,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
