先心病体外循环围术期血浆C型利钠肽与内皮素-1水平变化的相关性研究

目的:动态观察血浆C型利钠肽(CNP)与内皮素-1(ET-1)水平在体外循环(CPB)围术期的变化。方法:用放射免疫法对48例先心病患者在CPB围术期分别于全麻插管前、转机后30min、主动脉开放后30min、术后6h及术后24h,测定血浆中CNP与ET-1的含量。结果:血浆CNP水平,CPB后30min(138.6±39.2pg/ml)及开放升主动脉后(148.1±38.2pg/ml)与术前(204.9±66.0pg/ml)比较显著降低(P<0.01);术后6h(209.5±70.6pg/ml)与CPB后30min及开放升主动脉后比较显著升高(P<0.05);术后24h(153.6±41.2pg/ml)与术后6h比较显著下降(P<0.05),接近正常对照组(168.46±59.2pg/ml)。ET-1水平在CPB后30min(18.0±27.0pg/ml)及开放升主动脉后(16.98±14.05pg/ml)低于术前(27.7±17.2pg/ml),且差异显著(P<0.01)。术后6h(22.4±16.6)显著回升(P<0.05),接近正常对照组(21.2±19.1pg/ml)。结论:先心病早期心功能良好者,血浆ET-1在CPB围术期的变化有利于维持正常的心血管功能;CNP在CPB围术期可作为预防心肌细胞受损的一种有效药物。

Study on the changes of C-type natriuretic peptide and endothelin-1 levels in plasma during cardiopulmonary bypass in patients with congenital heart disease

Objective: To detect plasma C-type Natriuretic Peptide(CNP) and Endothelin-1(ET-1) levels during Cardiopulmonary Bypass(CPB) and analyze reasons of dynamic changes. Methods: By using radio-immunossary, plasma levels of CNP and ET-1 of 48 patients with Congenital Heart Disease (CHD) were measured at pre-operation, 30min post-CBP, 30min post-declamp of aorta, 6h post-operation and 24h post-operation respectively during CPB. Results: The plasma CNP levels decreased markedly at 30min post-CBP(138.6±39.2 pg/ml) and 30min post-declamp of aorta(148.1±38.2 pg/ml)compared with pre-operation(204.9±66.0 pg/ml)(P<0.01). However, till 6h post-operation(209.5±70.6 pg/ml) the CNP increased significantly(P<0.05). Then it decreased significantly at 24h post-operation(153.6±41.2 pg/ml)(P<0.05) and was close to the normal group(168.46±59.2 pg/ml). Mean level of ET-1 at pre-operation(27.7±17.2pg/ml) was higher than that at 30min post-CBP(18.0±27.0pg/ml) and 30min post-declamp of aorta(16.98±14.05pg/ml), and there was statistic difference(P<0.01). At 6h post-operation(22.4±16.6) ET-1 increased significantly(P<0.05) and was close to the normal group(21.2±19.1pg/ml). Conclusion: At early stage of CHD, the plasma ET-1 level may be beneficial to maintain normal heart-vessel function during CPB. Meanwhile, the external CNP is an effective agent to prevent the injury of myocardiocytes.