周倩,邹小华,王丰,谌旻欢,全静,陈洁娟,高鸿
ZHOU Qian,ZOU Xiaohua,WANG Feng,CHEN Minhuan,QUAN Jing,CHEN Jiejuan,GAO Hong

• 1:贵州医科大学麻醉学院
• 2:贵州医科大学附院麻醉科

摘要(Abstract)：

目的 探讨术前不同水平N末端脑利钠肽(NT-proBNP)对体外循环下行心脏瓣膜置换术患者围术期并发症及预后的影响。方法 体外循环下行心脏瓣膜置换术患者193例，根据患者术前NT-proBNP的水平分别分为正常组(NT-proBNP≤88 ng/L)、轻度升高组(89 ng/L1 001 ng/L);记录患者术中手术时长、麻醉时长、转机时间、主动脉阻断时间、后并行时间、再灌注性室颤率、输入液体量、输入自体血量及失血量，记录患者术后ICU停留时间和住院时间，分析患者术后不良事件的发生率和再灌注室颤发生率。结果 与正常组比较，中度升高组和重度升高组转机时间和术中输入液体量增加，重度升高组术中失血量增加(P<0.05);与轻度升高组比较，中度升高组和重度升高组转机时间、主动脉阻断时间、后并行时间、术中输入液体量、术中失血量增加，差异有统计学意义(P<0.05);与正常组比较，中度升高组和重度升高组再灌注室颤发生率增加，术后不良事件发生率增加(P<0.05);与轻度升高组比较，重度升高组术后不良事件发生率显著增加，差异有统计学意义(P<0.05);与正常组比较，中度升高组和重度升高组ICU停留时间延长，重度升高组住院时间延长(P<0.05);与轻度升高组比较，重度升高组ICU停留时间及住院天数延长(P<0.05);与中度升高组比较，重度升高组住院时间延长，差异有统计学意义(P<0.05)。结论 术前NT-proBNP水平增高可导致体外循环心脏瓣膜置换术患者再灌注性室颤率、术后不良事件发生率、ICU停留时间及住院时间增加。
Objective To investigate the effect of different preoperative levels of N-terminal pro-brain natriuretic peptide(NT-proBNP) on perioperative complications and prognosis of patients undergoing cardiac valve replacement under cardiopulmonary bypass. Methods According to the preoperative NT-proBNP level, 193 patients undergoing cardiac valve replacement under cardiopulmonary bypass were divided into three groups: normal group(NT-proBNP≤88 ng/L), mild group(88 ng/L1 001 ng/L). The following information were documented, including intraoperative operation time, anesthesia-controlled time, transfer time, time to aortic occlusion, post-parallel cycle time, the rate of reperfusion ventricular fibrillation, fluid input volume, autologous blood input volume, blood loss volume, the length of ICU stay and length of hospital stay after surgery. The incidence of postoperative adverse events and the rate of reperfusion ventricular fibrillation were analyzed. Results When compared with normal group, the transfer time and intraoperative fluid input volumes in moderate and severe groups and the intraoperative blood loss volume in severe group were increased(P<0.05). When compared with mild group, transfer time, time to aortic occlusion, post-parallel cycle time, intraoperative fluid input volume and intraoperative blood loss volume were increased in moderate and severe groups(P<0.05). The rate of reperfusion ventricular fibrillation and the incidence of postoperative adverse events in moderate and severe groups were increased relative to normal group(P<0.05). The incidence of postoperative adverse events was significantly increased in severe group when compared to mild group(P<0.05). The lengths of ICU stay were significantly longer in moderate and severe groups than that in normal group(P<0.05). The length of hospital stay was significantly prolonged in severe group relative to normal group(P<0.05). The lengths of ICU stay and hospital stay were significantly prolonged in severe group relative to mild group(P<0.05). The length of hospital stay was significantly longer in severe group than moderate group(P<0.05). Conclusion Increased preoperative NT-proBNP level can lead to increased rate of reperfusion ventricular fibrillation, increased incidence of postoperative adverse events, prolonged lengths of ICU stay and hospital stay in patients undergoing heart valve replacement under cardiopulmonary bypass.

关键词(KeyWords)： 体外循环;心脏瓣膜置换术;N末端脑利钠肽;再灌注性室颤率;不良事件发生率
cardiopulmonary bypass;heart valve replacement;N-terminal pro-brain natriuretic peptide(NT-proBNP);rate of reperfusion ventricular fibrillation;incidence of adverse events

Abstract:

Keywords:

基金项目(Foundation): 贵州省卫生计生委科学技术基金(gzwjkj2019-1-165)

作者(Author): 周倩,邹小华,王丰,谌旻欢,全静,陈洁娟,高鸿
ZHOU Qian,ZOU Xiaohua,WANG Feng,CHEN Minhuan,QUAN Jing,CHEN Jiejuan,GAO Hong

DOI: 10.19367/j.cnki.2096-8388.2022.12.011

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