二尖瓣置換術(shù)患者圍術(shù)期NT-proBNP測定價值的初步研究
發(fā)布時間：2019-04-04 12:20
【摘要】：目的：探討二尖瓣置換術(shù)患者圍手術(shù)期血清N-末端腦鈉素原(NT--proBNP)濃度的變化規(guī)律和臨床意義以及其對患者早期預(yù)后的評估。方法：2014年1月-2014年7月,45例風(fēng)濕性二尖瓣病變患者接受體外循環(huán)下二尖瓣置換術(shù)�；颊咂骄挲g(48.13±10.46)歲,分別于術(shù)前、術(shù)后1天、術(shù)后5天、術(shù)后7天檢測血清N一末端腦鈉素原(NT--proBNP)濃度,分析研究圍手術(shù)期N-末端腦鈉素原(NT--proBNP)濃度的變化規(guī)律及臨床意義,術(shù)后根據(jù)患者是否發(fā)生不良事件分為兩組,不良事件組(n=21)與無不良事件組(n=24),比較兩組患者術(shù)前、術(shù)后第一天兩個時點(diǎn)血漿N-末端腦鈉素原(NT--proBNP)濃度是否存在差異,并用受試者操作特征曲線(receiver operating characteristic, ROC)方法評定術(shù)前、術(shù)后NT-proBNP對患者預(yù)后的評估能力。結(jié)果：術(shù)后1天、術(shù)后5天Log NT-proBNP(N-末端腦鈉素原的對數(shù))平均水平高于患者術(shù)前LogNT-proBNP水平,差異有統(tǒng)計學(xué)意義(P0.05)；術(shù)后7天與術(shù)前差異無統(tǒng)計學(xué)意義(P0.05)；整體LogNT-proBNP平均水平呈先升高后降低的趨勢。術(shù)后發(fā)生不良事件組(n=21)與無不良事件組(n=24)相比,術(shù)前、術(shù)后一天血清N-末端腦鈉素原(NT--proBNP)水平明顯升高,差異有統(tǒng)計學(xué)意義(P0.05)。用ROC方法評定術(shù)前、術(shù)后NT-proBNP對其預(yù)后的評估能力,術(shù)前NT-proBNP預(yù)測不良事件的曲線下面積為73.8%,術(shù)后一天NT-proBNP預(yù)測不良事件的曲線下面積為72%,因此我們可以以813.40pg/mL為截點(diǎn),若患者術(shù)前NT-proBNP水平高于該截點(diǎn),說明患者發(fā)生不良事件的幾率增加。結(jié)論：風(fēng)濕性二尖瓣瓣膜病患者圍手術(shù)期血清NT-proBNP濃度是反應(yīng)二尖瓣置換術(shù)后患者心功能狀態(tài)及預(yù)后的敏感指標(biāo)�？捎眯g(shù)前血清N-末端腦鈉素原(NT-proBNP)濃度評估患者預(yù)后。
[Abstract]:Aim: to investigate the changes and clinical significance of serum N-terminal pro-brain natriuretic peptide (NT--proBNP) concentration in patients undergoing mitral valve replacement and to evaluate its early prognosis. Methods: from January 2014 to July 2014, 45 patients with rheumatic mitral valve disease underwent mitral valve replacement under cardiopulmonary bypass. The mean age of the patients was (48.13 鹵10.46) years. Serum N-terminal pro-brain natriuretic peptide (NT--proBNP) levels were measured before, 1 day, 5 days and 7 days after operation, respectively. The changes and clinical significance of N-terminal pro-brain natriuretic peptide (NT--proBNP) concentration during perioperative period were analyzed and studied. After operation, the patients were divided into two groups according to the occurrence of adverse events, adverse event group (n = 21) and non-adverse event group (n = 24), and the patients were divided into two groups according to whether the patients had adverse events or not. To compare the difference of plasma N-terminal brain natriuretic peptide (NT--proBNP) concentration between the two groups before and on the first day after operation, and to evaluate the plasma N-terminal pro-brain natriuretic peptide (NT--proBNP) concentration by the (receiver operating characteristic, ROC) method of the subjects' operating characteristic curve before and after the operation. The ability of postoperative NT-proBNP to evaluate the prognosis of patients. Results: the mean level of LogNT-proBNP (logarithm of N-terminal pro-brain natriuretic peptide) on day 1 and day 5 after operation was significantly higher than that of preoperative LogNT-proBNP (P0.05). There was no significant difference between 7 days after operation and pre-operation (P0.05), but the average level of LogNT-proBNP increased first and then decreased. The level of serum N-terminal pro-brain natriuretic peptide (NT--proBNP) was significantly higher in the postoperative adverse event group than that in the non-adverse event group before and one day after operation (P0.05). ROC method was used to evaluate the prognosis of preoperative and postoperative NT-proBNP. The area under the curve for predicting adverse events by NT-proBNP before operation was 73.8%, and the area under curve for predicting adverse events by NT-proBNP at one day after operation was 72%. Therefore, we can use 813.40pg/mL as the cut-off point. If the preoperative NT-proBNP level is higher than the cut-off point, the risk of adverse events is increased. Conclusion: the serum NT-proBNP concentration in patients with rheumatic mitral valvular disease is a sensitive indicator of cardiac function and prognosis after mitral valve replacement. Preoperative serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration can be used to evaluate the prognosis of patients.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R614
，
本文編號：2453804
[Abstract]:Aim: to investigate the changes and clinical significance of serum N-terminal pro-brain natriuretic peptide (NT--proBNP) concentration in patients undergoing mitral valve replacement and to evaluate its early prognosis. Methods: from January 2014 to July 2014, 45 patients with rheumatic mitral valve disease underwent mitral valve replacement under cardiopulmonary bypass. The mean age of the patients was (48.13 鹵10.46) years. Serum N-terminal pro-brain natriuretic peptide (NT--proBNP) levels were measured before, 1 day, 5 days and 7 days after operation, respectively. The changes and clinical significance of N-terminal pro-brain natriuretic peptide (NT--proBNP) concentration during perioperative period were analyzed and studied. After operation, the patients were divided into two groups according to the occurrence of adverse events, adverse event group (n = 21) and non-adverse event group (n = 24), and the patients were divided into two groups according to whether the patients had adverse events or not. To compare the difference of plasma N-terminal brain natriuretic peptide (NT--proBNP) concentration between the two groups before and on the first day after operation, and to evaluate the plasma N-terminal pro-brain natriuretic peptide (NT--proBNP) concentration by the (receiver operating characteristic, ROC) method of the subjects' operating characteristic curve before and after the operation. The ability of postoperative NT-proBNP to evaluate the prognosis of patients. Results: the mean level of LogNT-proBNP (logarithm of N-terminal pro-brain natriuretic peptide) on day 1 and day 5 after operation was significantly higher than that of preoperative LogNT-proBNP (P0.05). There was no significant difference between 7 days after operation and pre-operation (P0.05), but the average level of LogNT-proBNP increased first and then decreased. The level of serum N-terminal pro-brain natriuretic peptide (NT--proBNP) was significantly higher in the postoperative adverse event group than that in the non-adverse event group before and one day after operation (P0.05). ROC method was used to evaluate the prognosis of preoperative and postoperative NT-proBNP. The area under the curve for predicting adverse events by NT-proBNP before operation was 73.8%, and the area under curve for predicting adverse events by NT-proBNP at one day after operation was 72%. Therefore, we can use 813.40pg/mL as the cut-off point. If the preoperative NT-proBNP level is higher than the cut-off point, the risk of adverse events is increased. Conclusion: the serum NT-proBNP concentration in patients with rheumatic mitral valvular disease is a sensitive indicator of cardiac function and prognosis after mitral valve replacement. Preoperative serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration can be used to evaluate the prognosis of patients.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R614
，
本文編號：2453804
本文鏈接：http://sikaile.net/yixuelunwen/waikelunwen/2453804.html
最近更新
教材專著
