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目的探讨氨基末端脑钠肽前体(NT-proBNP)在婴儿简单先天性心脏病围术期风险预测中的价值。方法对接受以左向右分流为主的先天性心脏病手术的25例婴儿进行围术期前瞻性观察研究,分别在术前和术后6、12、24、48 h采集静脉血样,利用电化学发光法测定血清NT-proBNP浓度水平,并记录同期临床指标。结果术前血清NT-proBNP浓度水平较正常对照显著升高,与临床心脏功能分级正相关,与心超射血分数(EF)负相关;术后6和12 h血清NT-proBNP浓度水平较术前显著增加(P<0.05),术后24和48 h较术前增加,但差异无统计学意义(P>0.05);各时点NT-proBNP浓度水平与机械通气时间、血管活性肌力评分、ICU滞留时间和住院时间均无明显相关。结论 NT-proBNP作为新的生物标记物,可作为术前心脏功能评价手段的重要补充,但作为婴儿期左向右为主的简单先天性心脏病术后风险预测因子的价值有待进一步研究确定。
Objective To investigate the value of NT-proBNP in the perioperative risk prediction of simple congenital heart disease in infants. Methods A total of 25 infants who underwent left-to-right shunt-based congenital heart surgery were prospectively studied. Preoperative and postoperative 6, 12, 24 and 48 h were used to collect venous blood samples, Chemiluminescence was used to measure serum NT-proBNP concentration and clinical indicators of the same period were recorded. Results The preoperative serum NT-proBNP level was significantly higher than that of the normal control group, positively correlated with clinical cardiac function grade and negatively correlated with the ultrasonographic ejection fraction (EF). The serum NT-proBNP levels at 6 and 12 h (P <0.05). The levels of NT-proBNP at 24 and 48 hours after operation were significantly higher than those before operation (P> 0.05). The levels of NT-proBNP at each time point were significantly correlated with the duration of mechanical ventilation, There was no significant correlation between ICU stay and hospital stay. Conclusion NT-proBNP as a new biomarker may be an important complement to preoperative evaluation of cardiac function. However, the value of NT-proBNP as a predictor of postoperative risk factors for simple congenital heart disease with left-to-right infancy remains to be determined.