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脑利钠肽和呼吸指数在心脏直视手术围术期的变化及临床意义
引用本文:林善文,苏月南,张声笋,张剑辉,饶惠清,刘瑞华.脑利钠肽和呼吸指数在心脏直视手术围术期的变化及临床意义[J].中国医学文摘:老年医学,2009(9):899-902.
作者姓名:林善文  苏月南  张声笋  张剑辉  饶惠清  刘瑞华
作者单位:[1]阳江市人民医院胸外科,广东529500 [2]阳江市人民医院急诊科,广东529500 [3]阳江市人民医院麻醉科,广东529500 [4]阳江市人民医院中央重症监护室,广东529500
基金项目:阳江市科技局科研立项课题(卫200601)
摘    要:目的研究脑利钠肽和呼吸指数在心脏直视手术围术期的变化及临床意义。方法对首次择期行心瓣膜置换术患者45例分别于术前30min、转机30min、停机时、停机1h、术后1d、术后7d各时点同步监测脑利钠肽、心肌钙蛋白T、呼吸指数的变化,并进行各指标的相关性研究。结果脑利钠肽水平在体外循环后及手术后均明显升高,至术后1d达到高峰值,术后7d水平脑利钠肽下降,但仍明显高于术前水平(P〈0.01);呼吸指数在体外循环后及手术后均明显升高,至体外循环10min时达到高峰值(P〈0.05或P〈0.01),术后7d回落至术前水平(P〉0.05)。脑利钠肽变化与心肌钙蛋白T呈正相关(r=0.48,P〈0.05);呼吸指数变化与脑利钠肽、心肌钙蛋白T均未显示相关意义(r=0.23,r=0.17,P〉0.05)。结论同步监测脑利钠肽和呼吸指数的变化为围术期如何保护心肺功能提供依据。

关 键 词:心脏直视手术  脑利钠肽  呼吸指数

The change of brain natriuretic peptide and respiratory index in perioperative period of open heart surgery and it' s clinical significance
Institution:LIN Shan-wen, SU Yue-nan, ZHANG Sheng-sun, et al. (Department of Thoracic Surgery, Yangjiang City People' s Hospital, Guangdong 529500, China)
Abstract:Objective To research on the change of brain natriuretic peptide and respiratory index in perioperative period of open heart surgery and its clinical significance. Methods In 45 patients underwent the first time cardiac valve replacement, at 30 rain before operation, CPB 30 rain, downtime, the downtime 1 h, 1 d and 7 d after operation, the synchronous monitoring of the brain natrittretic peptide, cardiac troponin T, respiratory index were performed, and the relevance of the research indicators were analysed. Results The level of brain natriuretic peptide after cardiopulmonary bypass surgery were significantly increased to a peak value at 1 d after operation, at 7 d after operation brain natriuretic peptide levels decreased, but still significantly higher than preoperative levels ( P 〈 0. 01 ) ; respiratory index after cardiopulmonary bypass surgery were significantly increased and reached the peak value at 10 mira of cardiopulmonary bypass (P 〈0. 05 or P〈0.01), and dropped to preoperative levels at 7 d after operation (P 〉0. 05). There was a positive correlation between brain natriuretic peptide and cardiac troponin T (r = 0. 48,P 〈 0. 05 ) ; respiratory index and brain natriuretie peptide, cardiac troponin T did not show the relevance (r = 0. 23, r = 0. 17 ,P 〉 0. 05). Conclusion Synchronous monitoring of brain natriuretie peptide and respiratory index can to provide a basis for the protection of perioperative cardiopulmonary function.
Keywords:Open heart surgery  Brain natriuretie peptide  Respiratory index
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