室间隔缺损并发肺动脉高压患儿手术前后血浆心钠素临床研究

目的:研究室间隔缺损(VSD)并发不同程度肺动脉高压(PH)患儿体外循环手术前后血浆心钠素(ANP)含量的变化。方法:对50例VSD患儿,其中并发肺动脉高压(肺动脉高压组)36例(轻度肺动脉高压17例,中度肺动脉高压12例,重度肺动脉高压7例);肺动脉压正常(非肺动脉高压组)14例,及30例1.5～14岁的健康儿童(对照组),采用放射免疫分析法检测体外循环手术前、术后1、2、3、5d血浆ANP浓度。结果:1VSD伴轻、中、重度PH患儿血浆ANP表达水平均高于VSD不伴PH组及对照组;血浆ANP浓度随肺动脉高压程度的加重而升高,与肺动脉收缩压呈正相关;2VSD伴轻、中、重度PH患儿术后第5天其血浆ANP表达均有下降,与术前相比差别具有显著性差异。结论:VSD伴肺血流量增加及肺动脉高压时,显示血浆ANP浓度升高,并可做为患儿手术效果评价的血清学指标。

Study of plasma atrial natriuretic peptide concentration in children with ventricular septal defect with pulmonary hypertension

Objective：To study the changes of plasma atrial natriuretic peptide （ANP） in children with ventricular septal defect with pulmonary hypertension before and after cardiopulmonary bypass. Methods..50 children with ventrieular septal defect, including 36 pulmonary hypertension （PH） children and 14 non PH children, PH children, 12 had mild, 12 moderate and 7 severe PH, 30 healthy children were taken to form the control group, No difference were found between those groups in sex and age. The concentration of plasma atrialnatriuretic peptide in the peripheral veins was measured by radioimmunoassay in children with ventricular septal defect before and after cardiopulmonary bypass1,2,3 and 5 days. Result： （1）The concentrations of plasma ANP in children with pulmonary hypertension children were higher than those in children with non PH and the controls; The severer the PH was, the higher the ANP concentrations, ANP concentrations were positively correlated with pulmonary artery systolic pressure ;（2）The plasma ANP were decreased after surgery fivth days as compared with before surgery all in children of ventricutar septal defect with PH. Conclusion： The plasma ANP levels are increased in the children with ventrieular septal defect with pulmonary hypertension, ventricular septal defect accompanined by increased pulmonary blood inflow volume and PH may induce the elevation of the ANP concentrations. And as a serology index for estimated the effective of operation.