上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

氨基末端脑钠肽前体在婴儿简单先天性心脏病围术期风险预测中的价值

白凯1，陈笋1，梅举2，丁芳宝2，刘惠东1，孙锟1   

  1. 上海交通大学 医学院附属新华医院 1.小儿心血管科， 2.心胸外科， 上海 200092
  • 出版日期:2015-08-28 发布日期:2015-09-30
  • 通讯作者: 孙锟, 电子信箱: sunkun@sh163.net。
  • 作者简介:白凯（1969―）， 男， 副主任医师， 博士; 电子信箱: kaibai311@hotmail.com。

Value of N-terminal-pro-brain natriuretic peptide for predicting risk during peri-operation for infants with simple congenital heart disease

BAI Kai1, CHEN Sun1, MEI Ju2, DING Fang-bao2， LIU Hui-dong1， SUN Kun1   

  1. 1.Department of Pediatric Cardiology, 2.Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
  • Online:2015-08-28 Published:2015-09-30

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摘要：

目的  探讨氨基末端脑钠肽前体（NT-proBNP）在婴儿简单先天性心脏病围术期风险预测中的价值。方法  对接受以左向右分流为主的先天性心脏病手术的25例婴儿进行围术期前瞻性观察研究，分别在术前和术后6、12、24、48 h采集静脉血样，利用电化学发光法测定血清NT-proBNP浓度水平，并记录同期临床指标。结果  术前血清NT-proBNP浓度水平较正常对照显著升高，与临床心脏功能分级正相关，与心超射血分数（EF）负相关；术后6和12 h血清NT-proBNP浓度水平较术前显著增加（P<0.05），术后24和48 h较术前增加，但差异无统计学意义（P>0.05）；各时点NT-proBNP浓度水平与机械通气时间、血管活性肌力评分、ICU滞留时间和住院时间均无明显相关。结论  NT-proBNP作为新的生物标记物，可作为术前心脏功能评价手段的重要补充，但作为婴儿期左向右为主的简单先天性心脏病术后风险预测因子的价值有待进一步研究确定。

关键词: 氨基末端脑钠肽前体, 心脏手术, 风险预测, 婴儿

Abstract:

Objective  To explore the value of N-terminal-pro-brain natriuretic peptide (NT-proBNP) for predicting the risk during peri-operation for infants with simple congenital heart disease. Methods  A prospective study of 25 infants with congenital heart disease who underwent open-heart surgery of left-to-right shunt was conducted. Venous blood samples were collected before operation and 6, 12, 24, and 48 h after operation. Serum NT-proBNP levels were detected by electrochemical luminescence and clinical indexes were recorded. Results  Preoperative serum NT-proBNP levels were significantly higher than normal levels and positively correlated with Ross scores and negatively correlated with ejection fraction (EF). Serum NT-proBNP levels 6 and 12 h after operation were significantly higher than those before operation （P<0.05） and serum NT-proBNP levels 24 and 48 h after operation were higher than those before operation, but the differences were not statistically significant (P>0.05). NT-proBNP levels at different time points were not significantly correlated with the duration of mechanical ventilation, vasoactive-inotropic score, ICU stay time, and hospitalization time. Conclusion  As a novel biomarker, NT-proBNP can be used as an important complementary factor for evaluating preoperative cardiac function. But the value of using NT-proBNP as a factor for predicting the postoperative risk for infants with congenital heart disease who have undergone open-heart surgery of left-to-right needs further study.

Key words: N-terminal-pro-brain natriuretic peptide, cardiac surgery, risk prediction, infant