全腔静脉肺动脉连接手术前后血浆心钠素含量变化及其临床意义

目的　探讨全腔静脉肺动脉连接手术 (TCPC)前后心钠素 (ANP)的变化情况及其临床意义。方法　观察组为 18例全腔静脉肺动脉连接术患者 ;对照组选择 18例房间隔缺损、室间隔缺损心内修复术患者 ,两组分别于术前、术后第 1天、第 5天、第 4周和术后 6个月测量其心钠素含量。结果　观察组ANP含量术后第 1天显著下降 (t=2 6 2 3,P <0 0 1) ,此后直至出院前均显著高于对照组 ,术后 6个月时两组间无差别。观察组 7例术后出现胸腔积液并发症 ,其早期心钠素含量显著低于未发生该并发症的 11例患者 (P <0 0 5 )。结论　TCPC术后 ,因完全旷置右心 ,右房压显著下降 ,早期心钠素分泌量不足 ,这可能会导致机体水盐代谢失衡 ,与术后早期胸腔积液并发症密切相关。

Study of ANP in patients undergoing total cavopulmonary connection

Objective To study the changes of atrial natriuretic peptide(ANP) in patients undergoing total cavopulmonary connection and its clinical significance. Methods 36 patients were evaluated 18 patients underwent total cavopulmonary connection (TCPC) and 18 patients underwent definitive repair for ventricular septal defect and atrial septal defect. Blood samples for measurement of ANP were obtained in the pre-operative, post-operative and followe-up period. Results Plasma levels of ANP in experimental group were significantly lower on first day after the operation(t=2.623, P<0.01); In study group, 7 patients had complications of hydrothorax, and their ANP levels were significantly lower than other 11 patients in the early post-operative period(P<0.05). Conclusion The release of ANP can be suppressed in patients undergoing total cavopulmonary connection. The impairment of this response in the early postoperative period may have some correlations with hydrothorax complications.