rh-BNP对扩张性心肌病伴重度二尖瓣反流患者行二尖瓣置换术血流动力学影响
| 作者: |
1张步升,
1郑悦,
1方亮,
1戴黄栋,
1朱丹,
1孔烨
1 上海交通大学附属胸科医院心外科，上海 200030 |
| 通讯: |
孔烨
Email: kongye2008@gmail.com |
| DOI: | 10.3978/j.issn.2095-6959.2016.11.012 |
摘要
目的：观察持续静脉应用重组人脑利钠肽(recombinant human brain natriuretic peptide，rh-BNP)对扩张性心肌病伴重度二尖瓣反流患者行二尖瓣置换术围术期血流动力学的影响。方法：在2012年1月至2016年06月期间，对扩张性心肌病伴重度二尖瓣反流行二尖瓣置换术的患者随机分组，其中对照组32例，rh-BNP组33例。对照组实施常规治疗，rh-BNP组在常规治疗基础上加用rh-BNP。观察比较两组患者围术期肺毛细血管楔压(pulmonary capillary wedge pressure，PCWP)、心脏排血指数(cardiac index，CI)、左心室射血分数(left ventricular ejection fraction，LVEF)、左心室短轴缩短率(left ventricular fractional shortening，LVFS)及左心室舒张末期内径(left ventricular end diastolic dimension，LVDd)。结果：与术前相比，两组术后均表现为PCWP降低，CI升高，比较有显著性差异(P<0.05)，而LVEF、LVFS、LVDd无明显变化(P>0.05)。与对照组相比，rh-BNP组患者术后PCWP明显降低，CI明显升高，比较有显著性差异(P<0.05)，而LVEF、LVFS、LVDd变化亦无显著性差异(P>0.05)。结论：在扩张性心肌病伴重度二尖瓣反流行二尖瓣置换术的患者中，rh-BNP能够降低PCWP，提高CI，从而改善围术期的血流动力学。
关键词：
重组人脑利钠肽
扩张性心肌病
二尖瓣反流
二尖瓣置换术
血流动力学
The clinical research of rh-BNP on the hemodynamics in patients with dilated cardiomyopathy and severe mitral regurgitation who underwent mitral valve replacement
CorrespondingAuthor: KONG Ye Email: kongye2008@gmail.com
DOI: 10.3978/j.issn.2095-6959.2016.11.012
Abstract
Objective: To observe the clinical effects of continuous application of recombinant human brain natriuretic peptide (rh-BNP) on perioperative hemodynamics in patients with dilated cardiomyopathy and severe mitral regurgitation when underwent mitral valve replacement. Methods: Between Jan 2012 and Jun 2016, the patients with dilated cardiomyopathy and severe mitral regurgitation who underwent mitral valve replacement were randomly divided into the control group (n=32) and rh-BNP group (n=33). In control group, the patients were treated with routine treatment, and the patients in rh-BNP group were treated with continuous application of rh-BNP and routine treatment. Perioperative data including pulmonary capillary wedge pressure (PCWP), cardiac index (CI), left ventricular ejection fraction (LVEF), left ventricular fractional shorting (LVFS), left ventricular end-diastolic dimension (LVDd) were observed and compared between the two groups. Results: In two groups, PCWP was markedly decreased and CI was markedly increased after the surgery (P<0.05). Compared with those in control group, PCWP was more decreased and CI was more increased after the surgery (P<0.05), while there was no significant difference in LVEF, LVFS and LVDd (P>0.05). Conclusion: In patients with dilated cardiomyopathy and severe mitral regurgitation who underwent mitral valve replacement, continuous application of rh-BNP could significantly decrease PCWP and increase CI, therefore improve perioperative hemodynamics.