心瓣膜疾病患者围手术期脑钠素浓度的变化

目的 观察心瓣膜置换术患者围手术期血清脑钠素(brain natriuretic peptide, BNP)浓度的变化规律.方法 20例心瓣膜置换术患者按NYHA心功能标准分级,术前进行超声心动图检查,测量左心室射血分数(LVEF),于术前、术后24小时、7天、14天和30天测量血清BNP浓度,分析围手术期BNP浓度变化趋势,术前BNP浓度与心功能、LVEF的关系. 结果心瓣膜疾病患者术后BNP浓度急剧上升,24小时达峰值(P＝0.003);术后7天明显下降,但仍高于术前水平(P＝0.015);术后14天恢复至术前水平,术后30天略低于术前水平.术前心功能NYHA分级与BNP水平呈正相关(r=0.69,P＜0.05),LVEF与BNP浓度无相关关系(r＝0.29,P＞0.05). 结论术前血清BNP浓度能反映心瓣膜置换术患者术前心功能状况,血清BNP浓度越高,心功能越差.术后早期BNP浓度升高,后期呈下降趋势.     

脑钠素与临床麻醉

麻醉前心功能的评估、麻醉期循环的稳定及术后血流动力学的改善一直是临床麻醉特别是心血管麻醉工作的重点;脑钠素(brain natriuretic peptide,BNP)作为反映心功能的生化指标,和临床麻醉有着紧密的联系,而且麻醉方式、麻醉药物和通气模式也对BNP的浓度产生一定的影响.     

氯沙坦对维持性血液透析患者脑钠素的影响

目的：观察氯沙坦对维持性血液透析（MHD）患者脑钠素（BNP）水平的影响.方法：选取伴有高血压的MHD患者48例,随机分为安慰剂组和氯沙坦组,安慰剂组每位患者每日口服安慰剂,氯沙坦组每位患者口服氯沙坦50~100 mg/d,两组分别于治疗前、后3个月分别测定BNP水平.结果：与实验前相比,实验后1个月氯沙坦组BNP明显降低,差异具有统计学意义[（992.4±238.9）pg/ml VS （618.5±243.6）pg/ml,P〈0.01],而安慰剂组无明显变化[（978.3±226.5）pg/ml VS（989.7±235.1）pg/ml,P〉0.05].结论：氯沙坦可降低MHD患者BNP水平,从而减少心血管病发生的风险,提高患者的生活质量,其具体机制有待于进一步研究.     

急性冠状动脉综合征患者使用辛伐他汀后血清基质蛋白酶9及C反应蛋白含量的变化

目的:探讨辛伐他汀对急性冠状动脉综合征(ACS)患者血清基质蛋白酶9(MMP-9)及C反应蛋白(CRP)含量的影响.方法:53例ACS患者被随机分为观察组27例和对照组26例,洲定治疗前、治疗4周后CRP和MMP-9水平.结果:2组治疗前CRP和MMP-9水平差异无统计学意义(p>0.05);治疗后2组CRP和MMP-9水平均明显低于治疗前,差异有统计学意义(p<0.05.p<0.01);治疗后观察组CRP和MMP-9水平明显低于对照组,差异有统计学意义(p<0.05).结论:辛伐他汀可降低ACS患者CRP和MMP-9水平.     

急性冠脉综合征院前急救及护理

目的:探讨急性冠脉综合征患者的院前急救及护理措施,提高抢救成功率及患者生存质量.方法:对36例急性冠脉综合征患者进行院前急救护理干预,给予及早、迅速、有效的救护.结果:除1例急性大面积心肌梗死病人,在送往医院途中突发呼吸、心搏骤停,经抢救无效死亡;其余35例病人接受急救护理,送往心内科住院治疗;其中1例死亡,33例均取得了满意的疗效.结论:对急性冠脉综合征患者应迅速、及早、正确、有效的进行院前急救护理干预,及早缓解病痛,同时为入院后的进一步介入治疗和冠脉内支架术赢得了宝贵的时间,提高了患者的生存率.     

急性冠脉综合征患者抑郁状态调查

目的了解急性冠脉综合征患者是否存在抑郁症状及其程度,以便为临床心理护理提供依据。方法采用抑郁 自评量表对85例急性冠脉综合征患者进行问卷调查。结果57.65%患者存在不同程度的抑郁症状;年龄<60岁 组较≥60岁组抑郁发生率高(P<0.05);抑郁发生与性别和病情无相关性。结论急性冠脉综合征患者的抑郁发 生率偏高,临床医护人员应给予足够的重视,采用多种措施缓解患者的抑郁症状,以维持患者的心理健康。     

Perioperative plasma brain natriuretic peptide and cardiotrophin-1 in off-pump coronary artery bypass

Objective. It has been suggested that brain natriuretic peptide (BNP) and cardiotrophin-1 (CT-1) are associated with myocardial dysfunction. The present prospective study was designed to investigate perioperative changes of plasma levels of BNP and CT-1 in off-pump coronary artery bypass (OPCAB). Method. Forty-nine patients undergoing elective OPCAB were divided into three groups. Group I: no previous myocardial infarction; Group II: previous myocardial infarction more than 12 weeks; Group III: recent myocardial infarction within 4–8 weeks. Perioperative BNP and CT-1 levels were measured, and hematochemical parameters were also collected. Results. Higher preoperative BNP and CT-1 levels were found in group III as compared to those in group I. BNP levels increased after operation, and reached peak value at 3–7 days after the operation. However, the postoperative changes of BNP levels were not different among groups in any time points. CT-1 levels did not change significantly after the operation as compared to baseline. Conclusion. Higher BNP and CT-1 levels were associated with recent myocardial infarction. BNP elevated after OPCAB, but CT-1 showed no significant postoperative changes. Postoperative changes of BNP and CT-1 do not associated with cardiac function in OPCAB.     

Changes in calcitonin gene-related peptide,atrial natriuretic peptide and brain natriuretic peptide in patients undergoing coronary artery bypass grafting

The initiation of cardiopulmonary bypass creates significant derangements in cardiovascular volume status and both endocrine and autonomic nervous system function. To examine whether such derangements might differ in patients with different pre-operative physical status scores, we measured the plasma concentrations of calcitonin gene-related peptide, atrial natriuretic peptide and brain natriuretic peptide, catecholamines and antidiuretic hormone, as well as haemodynamic variables, during and after cardiopulmonary bypass in 27 consecutive patients undergoing coronary artery bypass grafting. The pre-operative levels of atrial natriuretic peptide and brain natriuretic peptide differed significantly between ASA II patients and III and IV patients [mean (SD) brain natriuretic peptide levels = 14 (8.2) vs. 129 (51) pg.ml-1]. Plasma calcitonin gene-related peptide increased significantly in both groups after the initiation of cardiopulmonary bypass, and remained increased throughout cardiopulmonary bypass. The changes in plasma epinephrine, norepinephrine and antidiuretic hormone were similar to those reported previously. The changes in plasma calcitonin gene-related peptide, atrial natriuretic peptide and brain natriuretic peptide did not correlate with any changes in haemodynamic variables before or after cardiopulmonary bypass. Measurement of plasma brain natriuretic peptide might usefully be included in the pre-operative evaluation of patients with cardiac disease.     

Atrial and brain natriuretic peptide changes in an experimental model of intra-abdominal hypertension

Background

Intra-abdominal hypertension (IAH) can have a profound impact on the cardiovascular system. We hypothesized that natriuretic peptides (Nt-pro-ANP and Nt-pro-BNP) are produced in response to the cardiovascular changes observed in an experimental model of IAH.

Materials and methods

Eleven female pigs were enrolled in this study. Four experimental phases were created: a baseline phase for instrumentation (T₁); two subsequent phases (T₂ and T₃), in which helium pneumoperitoneum was established at 20 and 35 mm Hg, respectively; and the final phase (T₄), in which abdominal desufflation took place. Hemodynamic parameters and concentrations of Nt-pro-ANP and Nt-pro-BNP were measured.

Results

Central venous pressure and pulmonary capillary wedge pressure increased significantly during the elevation of intra-abdominal pressure (IAP) and returned to baseline after abdominal desufflation. Right and left transmural pressures remained unaffected by the elevation of IAP. Cardiac output decreased in phases T₂ and T₃ and was restored to baseline levels after abdominal desufflation. Systemic and pulmonary vascular resistances increased significantly with IAH and decreased after abdominal desufflation. Nt-pro-ANP did not change significantly in comparison to baseline. Nt-pro-BNP increased significantly in comparison to baseline at T₃ and T₄. Peak Nt-pro-BNP levels at T₃ (peak IAP) correlated positively with indices of afterload at this time point, that is, systemic vascular resistance and pulmonary vascular resistance (r² = 0.38, P = 0.042 and r² = 0.55, P = 0.009, respectively). A strong negative correlation between Nt-pro-BNP and cardiac output at T₃ was also demonstrated (r² = 0.58, P = 0.006).

Conclusions

IAH resulted in cardiovascular compromise. The unchanged Nt-pro-ANP concentrations might reflect unaltered atrial stretch with IAH, despite the elevation of right atrial filling pressure. The significant increase of Nt-pro-BNP in response to high levels of IAP may reflect left ventricular strain and dysfunction due to the severe IAH and provide an alternative marker in the monitoring of IAH.     

Atrial natriuretic peptide and N-terminal atrial natriuretic peptide in plasma reflect right ventricular volumes following coronary artery surgery

Background: Atrial natriuretic peptide (ANP) and the more stable N-terminal fragment (N-ANP) of prohormone are peptides, released in equimolar amounts from cardiac myocytes in response to atrial stretch or ventricular overload and myocardial ischaemia. Protection of the right ventricular (RV) myocardium during ischaemia in cardiac surgery is difficult, especially in patients with severe right coronary artery (RCA) disease. This prospective study was designed to ascertain a possible relationship between changes in plasma ANP/N-ANP concentration and RV function in RCA-diseased patients.
Methods: Plasma ANP and N-ANP concentrations and RV function, measured by fast-response thermodilution, were determined serially in 15 patients with total RCA stenosis and in another 15 with no significant RCA disease (controls) before, during and after coronary artery surgery.
Results: The RV ejection fraction was lower and the RV end-systolic volume index higher in the RCA-diseased patients than in the controls ( P < 0.05) on the second postoperative day, and both ANP and N-ANP were higher in the RCA patients ( P < 0.05) from 6 h after cardiopulmonary bypass till the second postoperative day. At the same time the changes in N-ANP concentrations from the levels before induction of anaesthesia correlated with RV ejection fraction and RV volume indexes, but not with heart rate or parameters indirectly reflecting left-sided loading. Right atrial pressure did not differ between the groups nor did it increase significantly during the study.
Conclusions: The relationships found between N-ANP and RV volume indexes and RV ejection fraction suggest ventricular expression of ANP: ANP release may be stimulated by RV distension, the more so the poorer the RV function.     

慢性肾脏病血清β-脑钠肽、同型半胱氨酸与心血管病变的关系

目的探讨血清β-钠肽（BNP）、同型半胱氨酸（Hcy）与慢性肾脏病（CKD）35期心血管事件的发生和病死率的关系。方法本组77例CKD患者,按NKF-DOQI指南分为CKD3期（A组）17例,CKD4期（B组）21例和CKD5期（C组）39例。正常对照组30例,观察各组临床表现、生化指标,血清BNP、Hcy等变化。同时,将77例患者根据Hcy数值分为升高组和正常组,观察其与心血管疾病（CVD）的相关性。结果与正常对照组比较,A、B、C组血肌酐（SCr）、尿素氮（BUN）、BNP明显升高,B组与A组比较,C组与B组比较,各组数值差异均有统计学意义。与Hcy正常组比较,Hcy升高组发生CVD明显增加,具有正相关关系。结论本研究显示,BNP和Hcy可作为慢性肾衰竭早期心血管损害的指标之一,BNP,Hcy与CVD发生及病死率的关系密切,BNP、Hcy越高,CVD的发生率越高,病死率也越高。     

Plasma B-type natriuretic peptide monitoring to evaluate cardiovascular function prior to organ procurement in patients with brain death

Background: The natriuretic peptide system plays an active role in the regulation of fluid balance and systemic vascular resistance. Assays of plasma concentrations of B‐type natriuretic peptide (BNP) may have a diagnostic role in evaluating myocardial function. We present our experience with BNP monitoring to assess myocardial function after the proclamation of brain death in potential organ donors. Methods: After the proclamation of brain death and prior to organ donation, a plasma BNP or aminoterminal pro‐BNP level was obtained. Additional information from the donor included shortening fraction (SF) or ejection fraction, central venous pressure (CVP) reading, and renal function including blood urea nitrogen and creatinine. When available, data from the pulmonary artery (PA) catheter including pulmonary capillary wedge pressure (PCWP) and cardiac index were also collected. Results: The cohort for the study included eight patients (age range: 6 months to 21 years). The diagnosis of brain death by clinical or radiological examination had been completed in all patients and the patients were scheduled for organ procurement. Myocardial contractility as assessed by echocardiogram using SF was within normal limits. The CVP varied from 7 to 12 mmHg (9 ± 2) and the PCWP was 10–11 mmHg in the two patients who had PA catheters in place. No patient was receiving inotropic medications. In five of the six patients, the BNP value was above the upper limit of normal (100 pg·ml^?1). In two patients, an NT‐pro‐BNP value was obtained and found to be higher than the upper limits of normal (450 pg·ml^?1). All eight patients were acceptable cardiac donors and the transplanted hearts functioned without difficulty in the recipients. Conclusions: Assays of plasma BNP concentrations have been shown to be helpful in differentiating myocardial dysfunction from primary lung disease in both the adult and pediatric population. However, our data demonstrate that mechanisms other than myocardial performance may regulate BNP levels in patients with severe central nervous system injury who progress to brain death. Our preliminary data suggest that these assays appear to be of limited value in assessing myocardial performance in this population.     

Atrial natriuretic peptide as a preload depressor in acute renal failure secondary to congestive heart failure

The present study was undertaken to verdy the hypothesis that infusion of atrial natriuretic peptide (ANP) might lower preload and be beneficial in the treatment of pulmonary congestion even without a diuresis in patients with acute renal failure (ARF) secondary to severe congestive heart failure (CHF). We studied 22 patients with ARF secondary to CHF. The mean age of the patients (14 men and 8 women) was 72 years (range 36 to 85 years). Seven of the patients had dilated cardiomyopathy, ten had ischemic heart disease, and five had valvular heart disease. ANP was infused intravenously and the following data before and 1 hour after the start of ANP infusion were recorded; urinary output, systemic blood pressure (SBP), pulmonary blood pressure (PBP), right atrial pressure (RAP), cardiac index (CI), heart rate (HR), and arterial blood oxygen pressure. Diastolic PBP were employed as plumonary capillary wedge pressure. Urinary output did not change. Mean SBP decreased from 92 to 85 mmHg (p < 0.05), and mean PBP decreased from 34 to 28 mmHg (p < 0.01). Mean RAP decreased from 11 to 9 mmHg (p < 0.01) and diastolic PBP decreased from 25 to 19 mmHg (p < 0.01). HR did not change significantly and CI increased 2.4 to 2.5 mi/min/m² (p < 0.05). Arterial blood oxygen partial pressure increased significantly from 71 to 82 mmHg (p < 0.05). In conclusion, ANP decreased and improved arterial blood oxygen partial prissure, though diuretic response to ANP is attenuated in ARF secondary to CHE. Infusion of ANP will be very beneficial in cases in which dyspnea and pulmonary edema due to elevation of preload are the principal clinical problems.     

Alteration in brain natriuretic peptide (BNP) plasma concentration following severe traumatic brain injury

Summary Background. Brain natriuretic peptide (BNP) is a potent natriuretic and vasodilator factor which, by its systemic effects, can decrease cerebral blood flow (CBF). In aneurysmal subarchnoid hemorrhage (aSAH), BNP plasma concentrations were found to be associated with hyponatremia and were progressively elevated in patients who eventually developed delayed ischemic deficit secondary to vasospasm. The purpose of the present study was to evaluate trends in BNP plasma concentrations during the acute phase following severe (traumatic brain injury) TBI. Methods. BNP plasma concentration was evaluated in 30 patients with severe isolated head injury (GCS < 8 on admission) in four time periods after the injury (period 1: days 1–2; period 2: days 4–5; period 3: days 7–8; period 4: days 10–11). All patients were monitored for ICP during the first week after the injury. Findings. The initial BNP plasma concentrations (42 ± 36.9 pg/ml) were 7.3 fold (p < 0.01) higher in TBI patients as compared to the control group (5.78 ± 1.90 pg/ml). BNP plasma concentrations were progressively elevated through days 7–8 after the injury in patients with diffused SAH as compared to patients with mild or no SAH (p < 0.001) and in patients with elevated ICP as compared to patients without elevated ICP (p < 0.001). Furthermore, trends in BNP plasma concentrations were significantly and positively associated with poor outcome. Interpretation. BNP plasma concentrations are elevated shortly after head injury and are continuously elevated during the acute phase in patients with more extensive SAH and in those with elevated ICP, and correlate with poor outcomes. Further studies should be undertaken to evaluate the role of BNP in TBI pathophysiology.