N末端脑钠肽前体对冠脉搭桥术后情况预测作用

目的探讨N末端脑钠肽前体(NT-pro BNP)水平对冠脉搭桥术术后并发症的预测作用及其预测精确程度。方法选择哈尔滨医科大学附属第四医院自2012年6月至2013年3月行冠脉搭桥术的40例患者为研究对象。于手术当天诱导麻醉前,测量40例行孤立冠脉搭桥术患者的术前血浆NT-pro BNP水平,探讨其与冠脉搭桥术后早期死亡(出院前或出院后30 d内)、引流过多(引流量>850 ml)、输血(新鲜冰冻血浆、浓缩红细胞悬液、冷沉淀凝血因子、去白细胞血小板等)、呼吸衰竭、机械通气时间延长(通气时间>12 h)、心房颤动、心衰综合征、使用主动脉内球囊反搏或者变力性药物支持血流动力学改变、谵妄、急性肾衰或内脏缺血发生情况的相关性。结果纳入研究的冠心病患者术前平均NT-pro BNP血浆水平为380.6 ng/L(92~3 496 ng/L)。心肺转流平均时间157 min(82~213 min),主动脉夹闭平均时间106 min(53~160 min)。术前NT-pro BNP血浆水平可精确诊断(ROC曲线下面积>0.8)机械通气时间延长、呼吸功能衰竭、变力性药物(肾上腺素)应用;NT-pro BNP中度诊断敏感(ROC曲线下面积0.7~0.8)为变力性药物(多巴胺)应用;NT-pro BNP较弱诊断敏感(ROC曲线下面积0.6~0.7)术后引流过多、血小板输入、心房颤动、心衰综合征。结论行孤立冠状动脉旁路移植术的冠心病患者术前血浆NT-pro BNP浓度是预测冠脉搭桥术术后情况的一项有价值的诊断方式。NT-pro BNP术前预测价值尤其适用于机械通气时间延长、呼吸功能衰竭、变力性药物(多巴胺,肾上腺素)应用。

Prediction effect of NT-proBNP on coronary artery bypass grafting

Objective To investigate the prediction and diagnosis accuracy of NT-proBNP plasma levels in postoperative complications of patients undergoing coronary artery bypass graft(CABG)surgery.Methods A retrospective study was performed on 40 cases of patients undergoing CABG who were admitted from June 2012 to March 2013.Before the induction of anesthesia on the day of surgery,the preoperative plasma levels of NT-proBNP in 40 patients undergoing isolated CABG were measured.To investigate the relevance between plasma NT-proB-NP level and coronary artery bypass surgery postoperative comphcations,such as early death(within 30 days or before discharge),too much drainage(volume more than 850 ml),blood transfusions(fresh frozen plasma,concentrated red blood cell suspension,cold precipitated blood clotting factor,and leukocyte platelet),respiratory failure and prolonged mechanical ventilation (duration of ventilation time more than 12 hours),atrial fibrillation,low cardiac syndrome,inotropic drug use hemodynamic ischemia or delirium,central nervous system,acute renal failure and liver ischemia.Results The average NT-proBNP plasma level was 380.6 ng/L(92 to 3 496 ng/L)in the study.The average time of cardiopulmonary transfer was 157 minutes(82 to 213 minutes),and the mean time of aortic dissection was 106 minutes(53 to 160 mi nutes).The preoperative NT-proBNP plasma level can be accurately diagnosed (ROC curve ＞ 0.8)mechanical ventilation time,respiratory failure,and the reagent (epinephrine)application;NT-proBNP moderate diagnostic sensitivity (the area of the ROC curve under the ROC curve is 0.7 to 0.8) was the application of the variable drug(dopamine).NT-proBNP was relatively weak in diagnostic sensitivity(under ROC curve area of 0.6 to 0.7),postoperative drainage was too much,platelet input,atrial fibrillation,and low cardiac row syndrome.Conclusion Forpatients with coronary disease undergoing isolated CABG the preoperative NT-proBNP plasma concentration is a valuable diagnostic method in the prediction of postoperative complications.The predictive value of preoperative NT-proBNP is especially suitable for prolonged mechanical ventilation,respiratory failure,atrial fibrillation,and inotropic drug application (dopamine,adrenaline).