重组人脑利钠肽治疗二尖瓣病变术后肺动脉高压的疗效观察

目的 :评估重组人脑利钠肽治疗二尖瓣病变术后肺动脉高压的临床效果。方法:48例二尖瓣置换或成形术后伴肺动脉高压的患者,随机分为治疗组(A组,25例)与对照组(B组,23例)。A组术后在常规治疗基础上予重组人脑利钠肽治疗,B组为常规治疗组。分别于术后用药前(T1)以及用药1 h(T2)、3 h(T3)、6 h(T4)和12 h(T5)动态观察两组患者体、肺循环血流动力学的变化情况,检测比较治疗前后血液环磷酸鸟苷(cyclic guanosine monophosphate,c GMP)和血栓素A2(thromboxane A2,TXA2)的变化。结果:A组T3、T4和T5时点的平均肺动脉压(mean pulmonary arterial pressure,MPAP)和肺动脉楔压(pulmonary capillary wedge pressure,PCWP)较T1明显下降(P<0.05),A组用药后各时点肺血管阻力指数(pulmonary vascular resistance index,PVRI)均较T1明显下降(P<0.05)。与B组比较,A组T3、T4和T5时点的MPAP和PCWP明显下降(P<0.05);与B组比较,A组用药后各时点的PVRI均明显下降(P<0.05)。A组术后c GMP水平较用药前明显升高,与B组比较亦明显升高(P<0.05);而TXA2水平则无明显变化。结论:重组人脑利钠肽可通过提高循环c GMP水平有效治疗二尖瓣病变术后的肺动脉高压。

Effects of recombinant human brain natriuretic peptide on patients with pulmonary hypertension after mitral valve surgery

Objective:To explore the clinical efficacy of recombinant human brain natriuretic peptide (rhBNP) on patients with pulmonary hypertension after mitral valve surgery. Methods:Forty eight patients with postoperative pulmonary hypertension after mitral valve surgery were randomly divided into rhBNP infusion group (group A,n=25) and control group(group B,n=23). Group A received recombinant human brain natriuretic peptide (rhBNP) after treatment,while group B did not. The hemodynamic data were monitored consecutively,and the levels of cyclic guanosine monophosphate (cGMP) and thromboxane A2 (TXA2) were detected pretreatment and after treatment. Results:The mean pulmonary arterial pressure and pulmonary capillary wedge pressure in group A decreased significantly 3 hours,6 hours,and 12 hours,respectively,after treatment,compared to group B (P < 0.05). Pulmonary vascular resistance index in group A decreased significantly 1 hour after treatment,compared to group B (P < 0.05). cGMP in group A increased significantly after the treatment,compared to group B (P < 0.05). TXA2 showed no significant difference within groups and between groups. Conclusion:rhBNP can effectively reduce pulmonary hypertension via increasing serum cGMP level.