迷宫手术保留右心耳对血浆心房钠尿肽的影响及其临床意义

为评价慢性心房颤动 (简称房颤 )施行迷宫手术时保留右心耳对心房钠尿肽 (ANP)分泌的影响 ,及其对肾脏水钠排泄功能的作用 ,选择行二尖瓣替换术和改良迷宫手术的风湿性心脏病 (简称风心病 )患者 43例 ,根据术中有无切除右心耳 ,分成切除组 (n =2 3)和保留组 (n =2 0 ) ,另选同期行二尖瓣和主动脉瓣替换术的风心病患者 2 0例作为对照组。各组分别于术前 1天、术后 1,3,7,14天采用放射免疫法测定血浆ANP的含量 ;同时记录术后 7天内每日液体的入量、尿量以及体重的变化。结果发现 ,切除组和保留组术后 1个月窦性心律的维持率无统计学差异 ;各组术后 7天内各时间点的血浆ANP含量均较术前明显降低 (P <0 .0 5 ) ,其中尤以术后第 1天下降最为明显 ;术后 3天保留组和对照组血浆ANP含量均较术后 1天明显升高 (P <0 .0 5 ) ;保留组术后第 3,7天血浆ANP含量显著高于切除组 (P <0 .0 5 ) ;术后每日液体入量、尿量、体重以及术后 7天体液的总平衡量各组间均无显著差异 (P >0 .0 5 ) ;切除组术后 7天内应用多巴胺和速尿的总量均显著高于保留组和对照组 (P <0 .0 5 )。提示保留右心耳的迷宫手术同样能达到治疗慢性房颤的目的 ,并且对ANP的分泌的影响相对较小、从而相对改善术后肾脏水钠排汇功能。

Effect of Preservation of the Right Atrial Appendage on Atrial Natriuretic Peptide Secretion and Its Clinical Significance After the Maze Procedure

The Maze procedure can effectively restore atrial fibrillation to sinus rhythm and to atrial systole.But concomitant atrial appendectomy may result a significant fluid retention during the early postoperative period.In order to determine whether preservation of the right atrial appendage during the Maze procedure lessens the decrease of plasma atrial natriuretic peptide(ANP) levels after the Maze procedure and whether the increase of plasma ANP improves the ability of the kidneys to excrete the fluid load after the operation,forty-three patients of rheumatic mitral valve disease who underwent concomitant prosthetic mitral valve replacement and the Maze procedure were divided into preservation group(Pre.Group,n=23) with the right atrial appendage preserved during the operation and conventional group(Con.Group,n=20) in which the right atrial appendage not preserved.Blood samples were obtained before and after the operation for measurement of ANP.Body weight,fluid balance and the doses of furosemide and dopamine administered after the operation were also measured.There was no significant difference between the two groups in the restoration rate to sinus rhythm at 1 month after operation.Plasma ANP levels were increased significantly 3 days after the operation than that of the first day in Pre.Group(P<0.05) but not in Con.Group.Moreover,plasma ANP levels were significantly lower in Con.Group than that in Pre.Group at 3 and 7 days after the operation(P<0.05).The fluid balance during the first 7 days of the postoperative period was comparable in the two groups,although the cumulative doses of dopamine and furosemide in the same period was significantly smaller in Pre.Group than in Con.Group.These results indicate that Maze operation with either preservation of the right atrial appendage or not can effectively restore atrial fibrillation to sinus rhythm.However,preservation of the right atria appendage during the Maze procedure improves reduced ANP secretion and reduced excretion of sodium after the operation,which may partly improve the ability of the kidneys to excrete the fluid load after the operation.