心包积液穿刺引流对心钠素释放的影响

目的探讨心包穿刺放液引起的心包腔内压、心房压变化与心房扩张，对心钠素（ＡＮＦ）释放的影响。方法对６例大量心包积液患者进行心包置管引流，记录引流前后的心包腔压力及尿量的变化，测定心包积液与血浆ＡＮＦ浓度。其中一例做血流动力学监测。结果心包穿刺放液前血浆ＡＮＦ低于正常水平，心包液ＡＮＦ高于血浆水平（Ｐ＜０．０５），放液后心包压、右房压下降，血浆ＡＮＦ反向升高（Ｐ＜０．０５），２４小时尿量增加，心包液ＡＮＦ明显下降，且低于血浆水平。结论心包积液穿刺放液刺激血浆ＡＮＦ的释放，产生利尿作用。ＡＮＦ的释放依赖于心房的扩张，而不是心房压的升高。心包具有分泌ＡＮＦ功能，其分泌量随心包腔内压增高而增加。

Effect of pericardiocentesis and drainage on the release of atrial natriuretic factor for pericardial effusion

Objective To explore the influence of changes of intrapercardial pressure and atrial pressure, atrial distention and release of atrial natriuretic factor (ANF) caused by pericardiocentesis and drainage Methods Pericardiocentesisntes and drainage were performed in 6 patients with cardic tamponade Intrapericardial pressure and 24 hours urine volume were measured before and after pericardial effusion drainage, at the meantime, pericardial effusion and plasma ANF were determined One of them was monitored hemodynamic Results Plasma ANF was lower than normal level and pericardial effusion ANF was higher than plasma ANF level ( P <0 05) before pericardiocentesis and drainage After pericardiocentesis, intrapericardial pressure and right atrial pressure was decreased, plasma ANF increased inversly and pericardial effusion ANF decreased significantly (lower than plasma ANF level P <0 05) Conclusion Pericardiocentesis and drainage may provide the stimulus for ANF release and diuresis The results of this study demonstrate that the release of plasma ANF is dependent on atrial distention and not on atrial pressure increase The pericardium can screte ANF and the higher intrapericardial pressure is, the more amounts it secretes