B型脑钠肽在冠状动脉旁路移植术后的变化规律及临床意义

目的研究B型脑钠肽在冠状动脉旁路移植手术后的变化规律，并找到其对冠心病患者术后心功能、循环指标、预后评价的客观依据。方法选取2010年10月至2012年3月行冠状动脉搭桥手术的患者共90例，根据其手术前第3天心脏彩超检测的左心室射血分数（LVEF）水平分为二组，A组LVEF≥45％；B组LVEF％45％，测定两组在不同时间的血浆B型脑钠肽浓度及心脏相关生物学指标，并进行分析。结果两组的主动脉阻断时间及体外循环时间的差异无统计学意义。冠状动脉旁路移植术后患者的BNP浓度自术后6h开始上升，术后24h达到高峰后逐渐下降，至术后36h仍维持在较高水平。在术前及术后时间二组间患者BNP水平差异有统计学意义，术前BNP水平与LVEF明显负相关，说明心脏功能越差，LVEF水平越低，BNP水平越高，患者的BNP水平可反映心脏功能状态。在术后时间A组较B组的肾上腺素用量、呼吸机应用时间、监护室滞留时间、心房纤颤的发生率有明显差异，说明BNP水平越高，患者心脏功能越差，应用大剂量的血管活性药物的剂量和强度越大，同时提示心房纤颤的高发生率。结论冠状动脉旁路移植患者围术期的BNP水平可反映患者的心脏功能状态．对术后患者的预后评估及康复治疗具有重要意义。

The value of BNP on the prognosis of coronary artery bypass grafting

Objective To study the value of BNP on the effect of coronary artery bypass grafting. Methods 90 cases with coronary artery bypass grafting from Oct. 2009 to Maroh. 2010 were divided into group A （LVEF≥45%） and group B （LVEF〈45%） based on the LVEF before the operation. The serum level of BNP was measured in dif- ferent times,respectively. Results Both of the two groups＇ aortic clamping time and CPB time had no difference. The levels of BNP were changed dramatically in six hours after operation compared. Before operation and after operation, the level of BNP were changed dramatically between the two groups. The lower the cardiac function and the LVEF are, the higher the BNP level is. The use of adrenalin, the time of ventilator and ICU stay and the incidence of myocar- dial infarction had dramatically difference in group A compared with the group B. The incidence of the atrial fibrilla- tion had dramatically difference between the two groups. Conclusion The level of BNP is in relation to the cardiac function of the patients with the coronary artery bypass grafting. It is very important for the evaluation and rehabili- tation of lhe patients after the operation.