风心病房颤患者围术期血浆心钠素变化的研究

为了解风心病房颤患者手术前后静脉、动脉、左心房和右心房血浆心钠素(pANP)的变化及相关因素。 方法采用放射免疫法(RIA)测定30例风心病合并房颤患者及30例风心病无房颤患者的血浆心钠素，并同时应用Swan-Ganz导管及左心房测压管测定心功能及各部位压力。 结果房颤患者pANP显著高于风心病无房颤组和正常对照组；手术后随心功能改善，心房压力下降pANP显著降低；不同时段动脉、静脉、左心房和右心房之间均有明显差异，以右心房最高，各部位含量与CI、CO均呈负相关；左心房内pANP与左心房大小、LAP、PCWP、SVRI呈正相关；右心房内pANP与右心房大小、CVP、PVRI呈正相关。结论心房颤动是刺激pANP分泌的重要因素;pANP测定是判断心功能的重要指标之一。

CLINICAL SIGNIFICANCE OF PLASMA ATRIAL NATRIURETIC PEPTIDE WITHIN PERIOPERATION OF RHEUMATIC HEART DISEASE WITH ATRIAL FIBRILLATION

To find out the clinical significance and the change of plasma atrial natriuretie peptide (pANP)in vein,artery,left atrium and right atrium of rheumatic heart disease (RHD) with atrial fibrillation (Af) within perioperation. Methods The levels of pANP were determined by radio-immunoassay in 30 RHD with Af and 30 RHD without Af and the haemodynamic and pressure data were measured simuitaneously with Swan-Ganz catheter and left atrial catheter. ResultsThe concentration of pANP was much higher in RHD patients with Af than that in RHD patients without Af and normal controls. After operation,the concentration of pANP decreased with the fall of atrial pressure and improvement of cardiac functions. The pANP levels have significant difference among vein,artery,left atrium and right atrium, but all of them have negative correlation relation to CO and Cl. The pANP levels of left atrium have positive correlation to the volume of left atrium, LAP,PCWP and SVRI. The pANP levels of right atrium have positive correlation to the volume of right atrium ,CVP and PVRI. Conclusion Af is an important factor to stiumlate pANP secretion. The level of pANP is a major marker for judging cardiac functions.