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目的 观察风湿性心脏病患者心瓣膜置换术前、后血浆肾上腺髓质素(AM)及肺血流动力学的变化,探讨AM在风湿性心脏病肺动脉高压中的作用。 方法 采用放射免疫法测定37例风湿性心脏病患者瓣膜置换术前、后血浆AM的浓度,Swan-Ganz漂浮导管测定肺血流动力学指标。 结果 风湿性心脏病患者术前血浆AM水平明显高于对照组(P<0.05),AM水平与平均肺动脉压、肺动脉楔压、肺血管阻力呈正相关(r=0.736,0.593和0.655,P<0.01);术后1周血浆AM水平都有不同程度的下降,并与肺动脉高压的改善有一定的关系。 结论 AM在风湿性心脏病肺动脉高压的病理机制中具有一定的作用
Objective To observe the changes of plasma adrenomedullin (AM) and pulmonary hemodynamics in patients with rheumatic heart disease before and after heart valve replacement and to explore the role of AM in pulmonary hypertension in rheumatic heart disease. Methods Radioimmunoassay was used to measure plasma concentrations of AM before and after valve replacement in 37 patients with rheumatic heart disease. Swan-Ganz floating catheter was used to measure pulmonary hemodynamics. Results The preoperative plasma AM level in patients with rheumatic heart disease was significantly higher than that in the control group (P <0.05). AM levels were positively correlated with mean pulmonary arterial pressure, pulmonary artery wedge pressure and pulmonary vascular resistance (r = 0.736, 0.593 and 0.655, P <0.01 ). Plasma AM level decreased to some extent one week after surgery and was related to the improvement of pulmonary hypertension. Conclusion AM plays a role in the pathogenesis of pulmonary hypertension in rheumatic heart disease