经胸室间隔缺损封堵术围术期氨基末端脑钠肽前体的变化研究

目的探讨经胸微创室间隔缺损封堵术围术期氨基末端脑钠肽前体(NT-proBNP)的变化规律,从而客观地对微创封堵术心肌损伤的程度进行评估。方法 2013年6月至2014年6月,我们选取符合条件的室间隔缺损患儿30例,采用经胸微创封堵术关闭室间隔缺损。分别于术前、术后1 h、2h、6 h、12 h、24 h、48 h、7 d共8个时间点,通过免疫定量分析仪,在床边快速测定血清NT-proBNP浓度,对比患儿术前及术后各时间点血清NT-proBNP的浓度变化趋势。结果所有病例拔管平均时间3.5±2.1h,均治愈出院,平均住院时间7.1±1.5d。封堵术后当时至术后6 h,NT-proBNP无明显变化;至术后12~24 h,NT-proBNP有升高,与各时间点比较均有统计学意义(P0.05),术后48 h逐渐下降至术前水平。结论经胸微创封堵术治疗室间隔缺损可致可逆性微小心肌损伤,术后床边快速检测NTproBNP,可早期识别和判断心肌损伤的程度,为临床防治术后并发症、促进患儿快速康复提供科学依据,方法简便,容易在临床推广应用,可作为筛查心肌损伤的手段。

Changes of N-terminal probrain natriuretic peptide during perioperative period of mini-invasive occlu-sion of ventricular septal defect

Objetive To explore the effects of mini-invasive occlusion for ventricular septal defect (VSD)on N-terminal probrain natriuretic peptide (NT-proBNP). Methods A total of 30 VSD children un-derwent mini -invasive occlusion.And serum NT-proBNP was detected by dry-type fluorescent quantitative an-alyzer at a total of 8 timepoints (i.e.baseline,1 h,2 h,6 h,12 h,24 h,48h &7 days post-operation).The changes of serum NT-proBNP concentration were compared at each timepoint.Results All cases had a remov-al of intubation within a mean time of 3.5 ±2.1 h postoperation and a hospital discharge within a mean time of 7.1 ±1.5 d.NT-proBNP had no obvious change from finishing moment of operation to postoperative 6 h;NT-proBNP significantly increased untill 12 -24 h postoperatively.And their comparisons with other timepoints were statistically significant (P <0.05);Then NT-proBNP gradually returned to preoperative levels. Conclu-sions Mini-invasive occlusion may cause reversible minor myocardial damage.Serum NT-proBNP may detect myocardial ischemia and anoxia early and provide scientific rationales for preventing and treating postoperative complications and promoting rapid recovery.Thus it may be used as a clinical screening tool for myocardial injury.