鲍慧慧,程晓曙,杨人强,吴延庆,苏海,李萍,姜醒华,程应樟,俞建华,游志刚

• 1: 南昌大学第二附属医院心内科南昌大学心血管病研究所
• 2:南昌大学第二附属医院心内科南昌大学心血管病研究所
• 3:南昌大学第二附属医院心内科南昌大学心血管病研究所
• 4:南昌大学第二附属医院心内科南昌大学心血管病研究所

摘要(Abstract)：

目的探讨风湿性心脏病二尖瓣狭窄患者行经皮球囊二尖瓣成形术(PBMV)前后及不同心律时,外周静脉血中心房利钠肽(ANP)和脑钠肽(BNP)变化及与血液动力学参数之间的关系。方法选择成功行PBMV的风湿性二尖瓣狭窄患者36例,其中窦性心律11例,心房颤动25例。于PBMV术前及术后1天、3天取外周静脉血,分别用放射免疫法和酶链免疫法测定血浆中ANP、BNP值;用心导管测定左房平均压(LAP)、肺动脉压(PAP);术后1天行超声心动图测左房内径(LAD)、二尖瓣口面积(MVA)、二尖瓣跨瓣压差(MPG)。结果PBMV术后ANP逐渐下降,由术前216.09±73.84pg/mL降至术后1天188.70±59.22pg/mL,术后3天140.70±41.53pg/mL(P<0.05),其中窦性心律组比心房颤动组ANP下降明显(64.09±32.89pg/mL比32.93±25.73pg/mL,P<0.05)。术后,窦性心律组中BNP先升高、后降低,由术前545.50±206.20pg/mL升至术后1天662.00±270.16pg/mL,术后3天降至430.05±206.30pg/mL(P<0.05);而心房颤动组BNP变化差异无统计学意义。术后1天与术前比较,ANP降低(ΔANP)与LAP下降相关性最好(r=0.565,P<0.01),BNP的差值(ΔBNP)与MPG的差值(ΔMPG)呈负相关(r=-0.474,P<0.05),而ΔANP/ΔBNP与MPG下降负相关(r=-0.556,P<0.05)。结论PBMV术后,窦性心律患者比心房颤动患者血浆中ANP、BNP下降明显。PBMV术能有效改善患者的血液动力学。ΔANP/ΔBNP比值是反应MPG变化的有效指标。

关键词(KeyWords)： 二尖瓣狭窄;心脏导管插入术;心钠素;利钠肽,脑;血液动力学现象

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 鲍慧慧,程晓曙,杨人强,吴延庆,苏海,李萍,姜醒华,程应樟,俞建华,游志刚

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