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二尖瓣置換術患者圍術期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:探討二尖瓣置換術患者圍手術期血清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后的評估。方法:2014年1月-2014年7月,45例風濕性二尖瓣病變患者接受體外循環(huán)下二尖瓣置換術;颊咂骄挲g(48.13±10.46)歲,分別于術前、術后1天、術后5天、術后7天檢測血清N一末端腦鈉素原(NT--proBNP)濃度,分析研究圍手術期N-末端腦鈉素原(NT--proBNP)濃度的變化規(guī)律及臨床意義,術后根據(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),比較兩組患者術前、術后第一天兩個時點血漿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)方法評定術前、術后NT-proBNP對患者預后的評估能力。結果:術后1天、術后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前LogNT-proBNP水平,差異有統(tǒng)計學意義(P0.05);術后7天與術前差異無統(tǒng)計學意義(P0.05);整體LogNT-proBNP平均水平呈先升高后降低的趨勢。術后發(fā)生不良事件組(n=21)與無不良事件組(n=24)相比,術前、術后一天血清N-末端腦鈉素原(NT--proBNP)水平明顯升高,差異有統(tǒng)計學意義(P0.05)。用ROC方法評定術前、術后NT-proBNP對其預后的評估能力,術前NT-proBNP預測不良事件的曲線下面積為73.8%,術后一天NT-proBNP預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,若患者術前NT-proBNP水平高于該截點,說明患者發(fā)生不良事件的幾率增加。結論:風濕性二尖瓣瓣膜病患者圍手術期血清NT-proBNP濃度是反應二尖瓣置換術后患者心功能狀態(tài)及預后的敏感指標?捎眯g前血清N-末端腦鈉素原(NT-proBNP)濃度評估患者預后。
[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.
【學位授予單位】:新疆醫(yī)科大學
【學位級別】:碩士
【學位授予年份】:2015
【分類號】:R614
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本文編號:2453804

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