Release and indication of plasma brain natriuretic peptide during perioperation of off-pump coronary artery bypass grafting

doi:10.3969/j.issn.2095-4344.2015.15.020

Abstract

Abstract:

BACKGROUND: Brain natriuretic peptide, an important serum marker for diagnosis of cardiovascular diseases, is crucial for risk factor analysis of cardiovascular diseases.
OBJECTIVE: To analyze the relationship between brain natriuretic peptide and hemodynamic parameters before and after coronary artery bypass grafting.
METHODS: Thirty patients with coronary heart disease undergoing coronary artery bypass grafting were selected, including 13 patients with left ventricular ejection fraction ≥ 50% (normal heart function) and 17 patients with left ventricular ejection fraction < 50% (cardiac insufficiency). Levels of plasma brain natriuretic peptides were detected at 1 day before transplantation, 7 hours, 1, 3, 5, 7 days after transplantation, and then the correlation between plasma brain natriuretic peptide levels and hemodynamic parameters was analyzed before and after coronary artery bypass grafting.
RESULTS AND CONCLUSION: Preoperative and postoperative levels of plasma brain natriuretic peptides were significantly lower in the patients with left ventricular ejection fraction ≥ 50% than those with left ventricular ejection fraction < 50%; while in each group, the level of brain natriuretic peptides was remarkably increased after coronary artery bypass grafting (P < 0.05 or P < 0.001). Preoperative brain natriuretic peptide levels were positively correlated with New York Heart Association classification grading, left atrial diameter and left ventricular diameter (r=0.61; r=0.34; r=0.67), but negatively correlated with echocardiographic left ventricular ejection fraction and cardiac output (r=-0.75; r=-0.70). The postoperative peak level of brain natriuretic peptides was positively correlated with New York Heart Association classification grading, echocardiographic left ventricular end diastolic diameter and pulmonary artery pressure (r=0.72; r=0.70; r=0.45). These findings indicate that the plasma level of brain natriuretic peptides before coronary artery bypass grafting shows a good correlation with left ventricular ejection fraction and left ventricular end diastolic diameter, which accurately reflect the state of cardiac function before coronary artery bypass grafting.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: Coronary Artery Bypass, Off-Pump, Coronary Artery Disease, Heart Diseases

CLC Number:

R318

Zhu Yong-feng, Zhang Xiang-li, Wang Li-cheng, Li Shao-ke, Liu Yang, Zhu Fang-tao. Release and indication of plasma brain natriuretic peptide during perioperation of off-pump coronary artery bypass grafting[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(15): 2399-1404.

Figures/Tables 2

2.1 参与者数量分析纳入患者30例，分为2组，治疗过程无脱落，全部进入结果分析。 2.2 两组患者一般资料比较见表1，两组患者分组流程图见图1。 2.3 两组冠心病患者冠脉旁路移植后各项指标所有患者均接受非体外不停跳冠脉旁路移植进行再血管化，移植后当天及移植后第1天均进行心电监护及血流动力学监测，并进行心电图检查，所有患者均未出现围术期心肌梗死。两组患者在气管插管时间，移植后ICU时间，移植后住院时间方面都没有明显差别，两组发生心律失常者差异无显著性意义。左心室射血分数< 50%组移植后应用血管活性药物者8例，明显高于左心室射血分数≥50%的3例。见表2。 2.4 两组患者围术期B型脑钠肽变化趋势两组患者移植后血浆B型脑钠肽浓度均显著升高，于移植后第1天达浓度高峰，随后开始逐渐下降，移植后第7天血浆浓度仍高于移植前水平(P < 0.05)，不同时间点两组间B型脑钠肽比较，于左心室射血分数≥50% 组显著低于左心室射血分数< 50%组(P < 0.05)。见表3。 2.5 围术期血浆B型脑钠肽水平与患者纽约心脏病协会心功能分级、心脏超声指标及心排量的相关关系使用SAS软件典型相关分析法检测术前B型脑钠肽水平与患者纽约心脏病协会心功能分级、入院超声心动指标以及血生化指标的相关性，结果显示：术前B型脑钠肽水平与纽约心脏病协会心功能分级、左房内径、左室内径呈正相关(r=0.61：r=0.34；r=0.67)；与左室射血分数(LVEF)、心排血量(CO)呈负相关(r=-0.75：r=-0.70)。术后血浆B型脑钠肽浓度峰值与患者纽约心脏病协会心功能分级、入院超声心动指标以及血生化指标的相关性，检测结果显示：术后B型脑钠肽峰值浓度与出院前纽约心脏病协会心功能分级、超声心动图左室直径、肺动脉压力呈正相关(r=0.72：r=0.70：r=0.45)。见表4。 2.6 并发症本组无围术期急性心肌梗死，无移植后死亡，无急性肝肾功能不全，无认知功能障碍，无肺部感染等严重并发症，见表2。未发生移植物过敏和免疫反应等不良反应。"

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