儿童先天性心脏病手术前后血浆脑钠肽变化的影响因素

目的通过对先天性心脏病(先心病)患儿手术前后血浆中脑钠肽(brain natriuretic peptide,BNP)的动态测定,了解不同先心病类型、手术过程等因素对BNP的影响。方法收集100例全身麻醉下进行小儿先心病手术的患儿做为研究对象,分为5种先心病类型。分别于术前、术后1天、2天、7天取患儿静脉血2ml检测BNP。结果先心病5组患儿术前BNP差异无统计学意义。术后BNP值组间差异有统计学意义。术后1天BNP与年龄(rs=-0.556,P<0.01)、体质量(rs=-0.489,P<0.01)、体外循环时间(rs=0.539,P<0.01)、机械通气时间(rs=0.354,P<0.01)存在相关关系。术后2天BNP与体外循环时间(rs=0.431,P<0.01)存在正相关关系,术后7天BNP与体外循环时间(rs=0.598,P<0.01)、术后1天乳酸水平(rs=0.357,P<0.05)存在正相关关系。结论不同先心病类型的患儿的术前BNP差异无统计学意义。术后BNP与体外循环时间存在较强的正相关性。

Impact factors on plasma levels of B-type natriuretic peptide in children with congenital heart disease in perioperative period

Objective To detect prospectively the effect factors on plasma concentration of B-type natriuretic peptide（BNP）in children with congenital heart disease before and after cardiac surgery.Methods BNP plasma concentration was measured by immunofluorescence dry quantitative method（Biosite）in 100 children with congenital heart disease on the day before and after surgical therapy（1st day,2nd day,7th day）.BNP levels were compared to perioperative data.Results Among five groups of congenital heart disease children,there were no significant difference of BNP level at preoperative day.On the other hand,there was significant difference for the BNP levels at postoperative days.Postoperative BNP plasma concentration was correlated to age（rs=-0.556,P 0.01）,to weight（rs=-0.489,P 0.01）,to cardiopulmonary bypass duration（rs=0.539,P 0.01）and to mechanical ventilation duration（rs=0.354,P 0.01）at the first day after surgery.BNP at 2nd day after surgery was correlated to cardiopulmonary bypass duration（rs=0.431,P 0.01）.BNP at 7th day after surgery was correlated to cardiopulmonary bypass duration（rs=0.598,P 0.01）,and to serum lactate concentration at the 1st postoperative day（rs=0.357,P 0.05）.Conclusion There is no significant difference in BNP levels among the children with various types of congenital heart disease before surgery.Postoperative BNP plasma concentration is obviously correlated to cardiopulmonary bypass duration.