心脏瓣膜置换术病人体外循环期间血浆内皮素、房钠利尿多肽和血流动力学变化

目的 了解体外循环（CPB）期间血浆内皮素（ET）、房钠利尿多肽（ANP）与血流动力学指标变化及其相互之间的关系。方法 用放射免疫法测定16例心脏瓣膜置换手术病人的术前及CPB期间血浆内皮素、房钠利尿多肽水平。结果 诱导前血浆ET为（2.68±1.8）pg/ml，与对照组[（2.22±0.7）pg/ml]相比无显著差异（P>0.05），而血浆ANP为（738±559）pg/ml，明显高于对照组[（72.7±14.5）pg/ml，P<0.001]。CPB期间血浆ET无明显变化，而血浆ANP在体外循环初期明显下降，停CPB时恢复至CPB前水平。CPB期间及停CPB时SVRI明显降低，血球压积（Hct）与血管阻力指数（SVRI）关系密切。结论 CPB期间血浆ET无明显变化，而血浆ANP下降为血液稀释所致，SVRI降低主要在于血液稀释。

Changes of plasma endothelin, atrial natriuretic peptide and hemodynamics during cardiopulmonary bypass in patients undergoing cardiac valve replacement surgery

Objective To observe the changes of plasma endothelin (ET), atrial natriuretic peptide (ANP) and hemodynamics during cardiopulmonary bypass (CPB) in patients undergoing cardiac valve replacement surgery. Methods Sixteen patients underwent cardiac valve replacement surgery were investigated. Plasma endothelin, atrial natriuretic peptide were measured with radioimmunoassay. Results Before the anesthesia induction, plasma endothelin levels [(2.68±1.8)] pg/ml were not significantly different from that in the control group [(2.22±0.7) pg/ml] while atrial natriuretic peptide levels was significantly higher [(738±559) pg/ml vs (72.7±14.5 pg/ml, P<0.001)]. Plasma ET concentration was constant during CPB period. Plasma ANP levels gradually decreased after CPB started and returned to basal levels when CPB stopped. During and after CPB, SVRI was significantly lower compared with that preanesthesia. SVRI was positively correlated with Hct. Conclusions Plasma ET concentration does not significantly vary during CPB period. The decrease of plasma ANP levels can attribute to hemodilution, which also accounts for lowed SVRI.