重组人脑利钠肽治疗非体外循环冠状动脉旁路移植术后撤呼吸机困难的疗效分析_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 蒲虹 , 黄晓波

四川省人民医院外科ICU，成都 610072;

Corresponding author：

蒲虹, Email: lc3428@126.com

Keywords：

重组人脑利钠肽; 冠状动脉旁路移植术; 非体外循环; 呼吸机撤除法

DOI：

10.7507/1007-4848.20140156

Video：

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目的探讨重组人脑利钠肽（rhBNP）治疗非体外循环冠状动脉旁路移植术（OPCAB）后撤呼吸机困难患者的有效性及安全性。方法回顾性分析2010年2月至2011年7月四川省人民医院接受OPCAB，术后带机时间超过48 h 20例患者的临床资料，其中男14例、女6例，年龄（64.03±12.71）岁。对20例撤机困难患者在常规治疗的基础上加用重组人脑利钠肽1.5 μg/kg静脉冲击，此后以0.075 μg/（kg· min）持续滴注48～72 h。比较使用重组人脑利钠肽前、后各临床指标的变化。结果围术期死亡3例（15%），死亡原因：2例发生严重感染，1例家属放弃治疗。5例术后发生急性肾功能衰竭（ARF），其中3例接受持续肾脏替代治疗（CRRT）；4例患者术后出现肺部感染。总体带呼吸机时间（4.31±1.95）d，使用重组人脑利钠肽（2.02±0.38）d后脱机。20例患者住ICU时间（6.23±1.87）d，住院时间（26.75±7.82）d。使用重组人脑利钠肽后左心室舒张期末内径（LVEDD）较术前明显缩小，左心室射血分数（LVEF）较术前明显增加；脑利钠肽（BNP）、中心静脉压（CVP）、血钠（Na）较术前明显降低（P<0.05）。17例患者均进行随访，随访时间3～6个月，患者恢复良好。结论基因重组人脑利钠肽可以扩张血管、降低中心静脉压、排钠利尿、延缓心肌重塑、减轻心脏负荷、增加心脏射血分数、从而改善OPCAB患者的临床结果。

Citation： 蒲虹, 黄晓波. 重组人脑利钠肽治疗非体外循环冠状动脉旁路移植术后撤呼吸机困难的疗效分析. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(4): 554-556. doi: 10.7507/1007-4848.20140156 Copy

1.	Akira S, Hata M, Niino T, et al. Continuous low-dose infusion of human atrial natriuretic peptide in patients with left ventricular dysfunction undergoing coronary artery bypass grafting. J Am Coll Cardiol, 2010, 55 (17):1844-1851.
2.	Richard C, Teboul JL. Weaning failure from cardiovascular origin. Intensive Care Med, 2005, 31 (12):1605-1607.
3.	黄晓波, 蒲虹, 吴娅秋.脑利钠肽对非体外循环冠状动脉旁路移植术后撤机的预测价值.四川医学, 2011, 32 (12):1873-1876.
4.	Krum H, Liew D. New and emerging drug therapies for the manag-ement of acute heart failure. Eur Heart J, 2003, 33 (11):515-520.
5.	宋康兴, 卢才义.脑利钠肽在神经内分泌系统和心肌重构中的作用.中国全科医学, 2009, 12 (7):614-616.
6.	Williams SG, Ng LL, O'brien R. Is plasma N-BNP a good indicator the functional reserve of failing hearts. Eur Heart J, 2004, 6 (7):891-900.
7.	Zapata L, Vera P, Roglan A, et al. B-type natriuretic peptides for prediction and diagnosis of weaning failure from cardiac origin. Intensive Care Med, 2011, 37 (3):477-485.
8.	毛斌, 陈菲, 邵娟娟, 等.非体外循环冠状动脉旁路移植术围术期脑钠肽变化特点及其临床意义.中国胸心血管外科临床杂志, 2011, 18 (4):309-312.
9.	Cuthbertson BH, Croal BL, Rae D, et al. N-terminal pro-B-type natriuretic peptide levels and early outcome after cardiac surgery:a prospective cohort study. Br J Anaesth, 2009, 103 (5):647-653.
10.	黄峻.急性心力衰竭诊断和治疗指南要点.中国社区医师, 2010, 38 (27):9.
11.	Kapoun AM, Liang F, O' young G, et al. B-type natriuretic peptide exert broad functional opppsition to transforming growth factor-beta in primary human cardic fibroblasts:fibrosis, myofibroblast conversion, proliferation, and inflammation. Circ Res, 2004, 94 (4):453-461.
12.	王芳芳, 丁志坚, 邹瑞秀, 等.重组人脑利钠肽治疗急性心肌梗死伴心力衰竭的疗效评价.南京医科大学学报:自然科学版, 2009 (3):372-375.
13.	重组人脑利钠肽临床研究协作组.重组人脑利钠肽和硝酸甘油治疗急性失代偿性心力衰竭疗效和安全性的随机, 开放, 平行对照的多中心临床研究.中华心血管病杂志, 2006, 34 (3):222-226.
14.	Kawakami R, Saito Y, Kishimoto I, et al. Overexpression of brain natriuretic peptide facilitates neutrophil infiltration and cardiac matrix metalloproteinase-9 expression after acute myocardial infarction. Circulation, 2004, 110 (21):3306-3312.
15.	Benharash P, Omari B. Administration of nesiritide in patients after coronary artery bypass surgery induces brisk diuresis. Am Surg, 2005, 71 (9):794-796.

1. Akira S, Hata M, Niino T, et al. Continuous low-dose infusion of human atrial natriuretic peptide in patients with left ventricular dysfunction undergoing coronary artery bypass grafting. J Am Coll Cardiol, 2010, 55 (17):1844-1851.
2. Richard C, Teboul JL. Weaning failure from cardiovascular origin. Intensive Care Med, 2005, 31 (12):1605-1607.
3. 黄晓波, 蒲虹, 吴娅秋.脑利钠肽对非体外循环冠状动脉旁路移植术后撤机的预测价值.四川医学, 2011, 32 (12):1873-1876.
4. Krum H, Liew D. New and emerging drug therapies for the manag-ement of acute heart failure. Eur Heart J, 2003, 33 (11):515-520.
5. 宋康兴, 卢才义.脑利钠肽在神经内分泌系统和心肌重构中的作用.中国全科医学, 2009, 12 (7):614-616.
6. Williams SG, Ng LL, O'brien R. Is plasma N-BNP a good indicator the functional reserve of failing hearts. Eur Heart J, 2004, 6 (7):891-900.
7. Zapata L, Vera P, Roglan A, et al. B-type natriuretic peptides for prediction and diagnosis of weaning failure from cardiac origin. Intensive Care Med, 2011, 37 (3):477-485.
8. 毛斌, 陈菲, 邵娟娟, 等.非体外循环冠状动脉旁路移植术围术期脑钠肽变化特点及其临床意义.中国胸心血管外科临床杂志, 2011, 18 (4):309-312.
9. Cuthbertson BH, Croal BL, Rae D, et al. N-terminal pro-B-type natriuretic peptide levels and early outcome after cardiac surgery:a prospective cohort study. Br J Anaesth, 2009, 103 (5):647-653.
10. 黄峻.急性心力衰竭诊断和治疗指南要点.中国社区医师, 2010, 38 (27):9.
11. Kapoun AM, Liang F, O' young G, et al. B-type natriuretic peptide exert broad functional opppsition to transforming growth factor-beta in primary human cardic fibroblasts:fibrosis, myofibroblast conversion, proliferation, and inflammation. Circ Res, 2004, 94 (4):453-461.
12. 王芳芳, 丁志坚, 邹瑞秀, 等.重组人脑利钠肽治疗急性心肌梗死伴心力衰竭的疗效评价.南京医科大学学报:自然科学版, 2009 (3):372-375.
13. 重组人脑利钠肽临床研究协作组.重组人脑利钠肽和硝酸甘油治疗急性失代偿性心力衰竭疗效和安全性的随机, 开放, 平行对照的多中心临床研究.中华心血管病杂志, 2006, 34 (3):222-226.
14. Kawakami R, Saito Y, Kishimoto I, et al. Overexpression of brain natriuretic peptide facilitates neutrophil infiltration and cardiac matrix metalloproteinase-9 expression after acute myocardial infarction. Circulation, 2004, 110 (21):3306-3312.
15. Benharash P, Omari B. Administration of nesiritide in patients after coronary artery bypass surgery induces brisk diuresis. Am Surg, 2005, 71 (9):794-796.

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重组人脑利钠肽治疗非体外循环冠状动脉旁路移植术后撤呼吸机困难的疗效分析

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