本文選題：重組人腦利鈉肽 + 非體外循環(huán)冠脈搭橋��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:觀察重組人腦利鈉肽(rhBNP)對非體外循環(huán)下冠脈搭橋患者術(shù)后心功能的影響;觀察rhBNP對于非體外循環(huán)下冠脈搭橋術(shù)患者監(jiān)護及住院總時間、心血管事件發(fā)生率的影響;觀察rhBNP應(yīng)用的安全性。方法:1將擬于我院接受非體外循環(huán)冠狀動脈搭橋術(shù)(OPCABG)的103例患者利用隨機數(shù)字表格法分為rhBNP組和對照組,其中rhBNP組52例、對照組51例。對照組:行OPCABG后帶氣管插管送ICU常規(guī)治療;rhBNP組:在常規(guī)治療基礎(chǔ)上,術(shù)后返回ICU后靜脈泵入rhBNP,先以1.5μg/kg的負(fù)荷量靜注,后以0.0075μg·kg~（-1）·min~（-1）的維持量持續(xù)靜脈泵入72小時;2兩組病例均在靜吸復(fù)合麻醉氣管插管下完成手術(shù);均常規(guī)于左側(cè)橈動脈放置動脈留置針以直接監(jiān)測血壓,于右側(cè)鎖骨下靜脈放置三腔Arrow靜脈留置管以泵入藥物,于右側(cè)頸內(nèi)靜脈置入Swan-Ganz導(dǎo)管以檢測相關(guān)指標(biāo),兩組病例參與手術(shù)操作人員及過程均相同。過程如下:常規(guī)給予消毒鋪單后行胸部正中切口,按照皮膚-皮下-肌肉-骨膜的順序依次切開,胸骨鋸縱行由上至下劈開胸骨,應(yīng)用電刀及骨蠟充分止血后游離左側(cè)胸廓內(nèi)動脈(由第4或5肋開始游離,向上游離至第1肋,向下游離至劍突),同時取材大隱靜脈(采取全開放方式),左側(cè)胸廓內(nèi)動脈遠(yuǎn)端離斷后切開、懸吊心包并囑麻醉師靜脈應(yīng)用肝素鈉(1mg/kg),左側(cè)胸廓內(nèi)動脈遠(yuǎn)端結(jié)扎止血。使用北京航天卡迪HK系列心臟穩(wěn)定器固定靶血管,常規(guī)冠狀動脈腔內(nèi)放置分流栓,以7-0或8-0 Prolence線連續(xù)縫合進(jìn)行端側(cè)、端端吻合,通常先行左側(cè)胸廓內(nèi)動脈與左前降支進(jìn)行端側(cè)吻合,然后根據(jù)造影結(jié)果判定靶血管,后行升主動脈-大隱靜脈端側(cè)吻合,再依次序貫吻合對角支、回旋系統(tǒng)及右冠系統(tǒng);主動脈近端吻合均使用吻合輔助器械(Anastomosis Assist Device),以6-0 Prolence線連續(xù)縫合吻合口。3分別于術(shù)前、術(shù)后即刻(用藥前)、術(shù)后24小時、術(shù)后48小時、術(shù)后7天抽取靜脈血,檢測B型腦鈉肽(BNP)以及肌鈣蛋白(c Tn I);分別于術(shù)前、術(shù)后即刻(用藥前)、術(shù)后24小時、術(shù)后48小時、術(shù)后7天行心臟彩色多普勒超聲心動圖檢查左心室射血分?jǐn)?shù)(LVEF);分別于術(shù)前、術(shù)后即刻(用藥前)、術(shù)后24小時、術(shù)后48小時、術(shù)后7天測定患者心排量(CO)及肺毛細(xì)血管楔壓(PAWP)。4每次取血樣3ml,抽血后30分鐘內(nèi)在4℃3000r/min離心機中離心10min,取上清液并于20min內(nèi)進(jìn)行檢測并記錄BNP以及c Tn I;由同一心臟超聲科醫(yī)生同一臺機器行心臟彩色多普勒超聲心動圖檢查并記錄LVEF;由置入成功的Swan-Ganz導(dǎo)管監(jiān)測并記錄CO、PAWP。5術(shù)后觀察心血管事件發(fā)生率。6計量資料采用均數(shù)±標(biāo)準(zhǔn)差(SX±)表示,組間比較采用t檢驗,兩樣本率的比較采用卡方檢驗或Fisher精確檢驗。結(jié)果:1兩組各有1例術(shù)中中轉(zhuǎn)體外循環(huán)而終止本項研究,實際參加本項研究例數(shù):rhBNP組51例、對照組50例。2兩組患者一般資料和橋血管情況比較:rhBNP組男性29人,女性21人,平均年齡62±7歲,吸煙者39人,血脂異常者29人,合并糖尿病者8人,合并高血壓者24人,平均左心室射血分?jǐn)?shù)51.24±3.26,平均血管橋數(shù)3.31±0.40,平均遠(yuǎn)端吻合口數(shù)3.20±0.40;對照組男性31人,女性19人,平均年齡64±9歲,吸煙者40人,血脂異常者30人,合并糖尿病者9人,合并高血壓者27人,平均左心室射血分?jǐn)?shù)50.34±2.79,平均血管橋數(shù)3.19±0.61,平均遠(yuǎn)端吻合口數(shù)3.30±0.31,兩組間比較差別無統(tǒng)計學(xué)意義(P0.05)。3 rhBNP組和對照組術(shù)前BNP比較,差別無統(tǒng)計學(xué)意義(P0.05);術(shù)后即刻(用藥前)BNP比較,差別無統(tǒng)計學(xué)意義(P0.05);術(shù)后24小時BNP比較,差別有統(tǒng)計學(xué)意義(P0.05);術(shù)后48小時BNP比較,差別有統(tǒng)計學(xué)意義(P0.01),術(shù)后7天BNP比較,差別有統(tǒng)計學(xué)意義(P0.05)。4 rhBNP組和對照組術(shù)前c Tn I比較,差別無統(tǒng)計學(xué)意義(P0.05);術(shù)后即刻(用藥前)c Tn I比較,差別無統(tǒng)計學(xué)意義(P0.05);術(shù)后24小時c Tn I比較,差別有統(tǒng)計學(xué)意義(P0.05);術(shù)后48小時c Tn I比較,差別有統(tǒng)計學(xué)意義(P0.05),術(shù)后7天BNP比較,差別無統(tǒng)計學(xué)意義(P0.05)。5 rhBNP組和對照組術(shù)前LVEF比較,差別無統(tǒng)計學(xué)意義(P0.05);術(shù)后即刻(用藥前)LVEF比較,差別無統(tǒng)計學(xué)意義(P0.05);術(shù)后24小時LVEF比較,差別有統(tǒng)計學(xué)意義(P0.05);術(shù)后48小時LVEF比較,差別有統(tǒng)計學(xué)意義(P0.01),術(shù)后7天LVEF比較,差別有統(tǒng)計學(xué)意義(P0.05)。6 rhBNP組和對照組術(shù)前CO比較,差別無統(tǒng)計學(xué)意義(P0.05);術(shù)后即刻(用藥前)CO比較,差別無統(tǒng)計學(xué)意義(P0.05);術(shù)后24小時CO比較,差別有統(tǒng)計學(xué)意義(P0.05);術(shù)后48小時CO比較,差別有統(tǒng)計學(xué)意義(P0.01),術(shù)后7天CO比較,差別有統(tǒng)計學(xué)意義(P0.05)。7 rhBNP組和對照組術(shù)前PAWP比較,差別無統(tǒng)計學(xué)意義(P0.05);術(shù)后即刻(用藥前)PAWP比較,差別無統(tǒng)計學(xué)意義(P0.05);術(shù)后24小時PAWP比較,差別有統(tǒng)計學(xué)意義(P0.05);術(shù)后48小時PAWP比較,差別有統(tǒng)計學(xué)意義(P0.01),術(shù)后7天PAWP比較,差別有統(tǒng)計學(xué)意義(P0.05)。8 rhBNP組發(fā)生心絞痛、室性心律失常、心肌梗死、低心排綜合征分別為5例(9.8%)、7例(13.7%)、2例(3.9%)及0例,對照組發(fā)生心絞痛、室性心律失常、心肌梗死、低心排綜合征分別為5例(10%)、8例(16%)、2例(4%)及1例(2%),兩組均未出現(xiàn)死亡病例。兩組患者住院期間心血管事件和死亡的發(fā)生情況差異無統(tǒng)計學(xué)意義(χ2=0.117,P=0.7320.05)。9 rhBNP組和對照組ICU平均時間分別為54±14小時、61±16小時,兩者比較t=2.33,P0.05,差別有統(tǒng)計學(xué)意義;兩組住院總時間分別為9±2.4天、10±1.3天,兩者比較t=2.59,P0.05,差別有統(tǒng)計學(xué)意義。結(jié)論:OPCABG術(shù)后應(yīng)用rhBNP可明顯改善患者的心功能;OPCABG術(shù)后應(yīng)用rhBNP可縮短術(shù)后監(jiān)護及住院總時間;應(yīng)用rhBNP安全、可靠;rhBNP對心血管事件發(fā)生率沒有明顯的升高或降低的作用。
[Abstract]:Objective: To observe the effect of recombinant human brain natriuretic peptide (rhBNP) on cardiac function after off-pump coronary artery bypass grafting (CPB), to observe the effect of rhBNP on the monitoring of patients with coronary artery bypass grafting under extracorporeal circulation and the total time of hospitalization, the incidence of cardiovascular events, and to observe the safety of the rhBNP application. Methods: 1 we will receive non extracorporeal circulation crowns in our hospital. 103 patients with artery bypass grafting (OPCABG) were divided into rhBNP group and control group by random digital table method, of which 52 cases in group rhBNP and 51 cases in control group. The control group was given ICU routine treatment with tracheal intubation after OPCABG; rhBNP group: on the basis of routine treatment, after the return of ICU, the venous pump entered rhBNP after the operation, and then was injected with a load of 1.5 u g/kg, then 0 The maintenance of 075 mu g. Kg~ (-1). Min~ (-1) was maintained for 72 hours, and 2 two cases were performed under the combined anesthesia and endotracheal intubation. All the cases were routinely placed on the left radial artery to monitor the blood pressure directly. The three cavity Arrow vein catheter was placed in the right subclavian vein to pump the drug and the right internal jugular vein was placed in S. The wan-Ganz catheter was used to detect the related indexes. The two groups of cases participated in the operation and the process were the same. The process was as follows: the routine was given after the sterilizing sheet was given in the middle incision, the skin subcutaneous muscle - periosteum was cut in order, the sternum saw the sternum from top to bottom, and the left left chest was free after the electroknife and bone wax were fully hemostat. The internal artery (from fourth or 5 ribs began to dissociate, free to first ribs, down to the sword process), and the large saphenous vein (all open mode), the left side of the distal thoracic artery was removed from the distal end, the pericardium was suspended and the anesthesiologist used heparin sodium (1mg/kg), and the left thoracic internal artery was ligated to the distal end of the thoracic artery. The use of Beijing space Cardy H The K series of cardiac stabilizers fixed the target vessels in the conventional coronary artery. The end to side and end to end anastomosis was performed continuously with 7-0 or 8-0 Prolence lines. Usually the left anterior thoracic artery and the left anterior descending branch were anastomosed to the end to side, and then the target tube was determined according to the results of the angiography, then the ascending aorta and the end to side anastomosis of the great saphenous vein were followed. Sequential anastomosis of diagonal branches, gyrations and right coronal systems; anastomosis auxiliary instruments (Anastomosis Assist Device) were used in the proximal anastomosis of the aorta, and the anastomotic.3 was sutured continuously with 6-0 Prolence lines before operation, immediately after the operation (before use), 24 hours after operation, 48 hours after operation, and 7 days after the operation to detect B type natriuretic peptide (BNP) and muscle. Calcium protein (C Tn I); before operation, immediately after operation (before use), 24 hours after operation, 48 hours after operation, and 7 days after operation, the left ventricular ejection fraction (LVEF) was examined by color Doppler echocardiography; the cardiac output (CO) and pulmonary capillary wedges were measured at 48 hours after operation, 24 hours after operation and 48 hours after operation. Pressure (PAWP).4 was taken every time 3ml of blood sample, 30 minutes after blood was pumped, 10min was centrifuged in 3000r/min centrifuge at 4 C, the supernatant was detected in 20min and BNP and C Tn I were recorded and C Tn I was recorded by the same heart ultrasound doctor with a color Doppler echocardiography of the same machine. Records CO, PAWP.5 after the observation of the incidence of cardiovascular events.6 measurement data using mean standard deviation (SX +), compared with t test, two sample rate compared to Chi square test or Fisher accurate test. Results: 1 two groups of 1 cases in the operation of cardiopulmonary bypass and end of the final study, the actual participation in the number of cases: rhBNP group 51 In the control group, the general data and the bridge vessel condition of the 50.2 two groups were compared: the rhBNP group was 29 men and 21 women, the average age 62 + 7 years old, 39 smokers, 29 dyslipidemia, 8 with diabetes, 24 with hypertension, average left ventricular ejection fraction 51.24 3.26, average vascular bridge number 3.31 + 0.40, average distal anastomosis number 20 + 0.40, 31 men and 19 women in the control group, the average age of 64 + 9 years, 40 smokers and 30 people with dyslipidemia, 9 people with diabetes, 27 people with hypertension, average left ventricular ejection fraction 50.34 + 2.79, average vascular bridge number 3.19 + 31, average distal anastomosis number, and the difference was not statistically significant (P0.05).3 R There was no statistical difference between group hBNP and control group before operation BNP (P0.05); there was no significant difference in BNP comparison (P0.05) after the operation (P0.05). The difference was statistically significant (P0.05) after 48 hours after operation (P0.05), and the difference was statistically significant (P0.01), and BNP comparison of 7 days after the operation, and the difference was statistically significant (P0.05).4 There was no statistical difference between group hBNP and control group before operation C Tn I (P0.05), and there was no statistical difference (P0.05) in C Tn I immediately after operation (P0.05), and the difference was statistically significant after 24 hours C Tn I. The difference was statistically significant 48 hours after the operation, and there was no statistical difference between the 7 days after the operation. There was no statistically significant difference between the P0.05.5 rhBNP group and the control group before operation (P0.05), and there was no statistically significant difference (P0.05) compared with LVEF before operation (P0.05). The difference was statistically significant (P0.05) at 24 hours after operation (P0.05), and the difference was statistically significant (P0.01) at 48 hours after operation (P0.01), and 7 days after the operation, the difference was statistically significant. There was no statistical difference between the P0.05.6 rhBNP group and the control group before operation (P0.05), and there was no statistically significant difference (P0.05) compared with CO before operation (P0.05). The difference was statistically significant (P0.05) at 24 hours after operation (P0.05); the difference was statistically significant (P0.01) at 48 hours after operation (P0.01), and 7 days after the operation, the difference was statistically significant. There was no statistical difference between group P0.05.7 rhBNP and control group before operation PAWP (P0.05), and there was no statistical significance (P0.05) compared with PAWP before operation (P0.05). The difference was statistically significant (P0.05) at 24 hours after operation, and the difference was statistically significant (P0.01) at 48 hours after operation (P0.01), and 7 days after operation, there was a difference. There were 5 cases (9.8%), 7 cases (13.7%), 2 cases (3.9%) and 0 cases in group.8 rhBNP, 7 cases (13.7%), 2 cases (3.9%), 5 cases (10%), 8 cases (16%), 8 cases (4%) and 7 patients in the control group. There was no significant difference in the incidence of cardiovascular events and deaths in the two groups (x 2=0.117, P=0.7320.05).9 rhBNP and the control group, the average time of ICU was 54 + 14 hours, 61 + 16 hours respectively, and the difference was t=2.33, P0.05, and the difference was statistically significant; the total hospital time in the two group was 9 + 2.4 days, 10 + 1.3 days, the two were compared. Compared with t=2.59, P0.05, the difference was statistically significant. Conclusion: the use of rhBNP after OPCABG can obviously improve the cardiac function of the patients; after OPCABG, the application of rhBNP can shorten the postoperative monitoring and the total time of hospitalization; the application of rhBNP is safe and reliable; rhBNP does not significantly increase or decrease the incidence of cardiovascular events.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R654.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張樹軍;張勇;馬玉磊;張培榮;;重組人腦利鈉肽治療COPD并發(fā)肺動脈高壓的臨床療效觀察[J];中國醫(yī)藥指南;2016年17期

2 高琴;胡漢臣;王培寧;;不同劑量重組人腦利鈉肽治療血液透析相關(guān)心律失常的效果比較[J];廣東醫(yī)學(xué);2016年06期

3 蒲虹;黃曉波;;重組人腦利鈉肽對膿毒癥誘導(dǎo)心功能障礙的影響[J];臨床麻醉學(xué)雜志;2016年03期

4 張霞;邢艷秋;王慧;;應(yīng)用血清NT-proBNP、Copeptin、ST2水平綜合評價重組人腦利鈉肽治療慢性心力衰竭的療效[J];中華臨床醫(yī)師雜志(電子版);2016年02期

5 丁月霞;陳益民;王沖沖;張銘華;;新活素治療心腎綜合征頑固性心力衰竭的臨床療效觀察[J];中國醫(yī)藥指南;2015年12期

6 付龍;郭亮;張月蘭;;重組人腦利鈉肽治療急性心力衰竭的血流動力學(xué)改變及臨床療效研究[J];中國全科醫(yī)學(xué);2014年17期

7 李宏麗;王小艷;石卉;張瑞英;;心力衰竭新標(biāo)記物臨床研究進(jìn)展[J];心臟雜志;2014年04期

8 鐘傳軍;陳細(xì)香;李昌;曾彬;;低劑量重組人腦利鈉肽對老年急性非ST段抬高型心肌梗死患者心功能及炎癥因子的影響[J];嶺南心血管病雜志;2014年02期

9 皇甫衛(wèi)忠;席建軍;程文俊;牛云楓;張蕓;杜海燕;王欣;高瑞英;董雙華;李麗君;;新活素對慢性心力衰竭的病人心功能、高敏C反應(yīng)蛋白及血漿NT-proBNP的影響[J];內(nèi)蒙古醫(yī)科大學(xué)學(xué)報;2013年04期

10 周琳;張靜;袁天陽;李揚雪;徐艷玲;戴t;;重組人腦利鈉肽對動脈硬化大鼠血管內(nèi)皮功能的影響[J];中國實驗診斷學(xué);2013年02期

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