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    室间隔缺损经胸小切口封堵术与体外循环修补术 对cTnI及NT-proBNP的影响

    Effects of perventricular device closure and cardiopulmonary bypass on the levels of cTnI and NT-proBNP in patients with ventricular septal defect

    • 摘要: 目的对比室间隔缺损经胸小切口封堵与体外循环修补术后心肌肌钙蛋白T(cTnI)及氨基末端脑钠肽前体(NT-proBNP)水平的变化,探讨cTnI及NT-proBNP在反映心脏损伤的不同特点,以及经胸小切口封堵术的优势。方法选2015年经胸超声心动图评估认为可行经胸小切口封堵的单纯室间隔缺损患儿共52例,其中32例接受封堵术, 20例接受体外循环修补术。分别于术后即刻、6、12、24 h,2、4、8天测定血清cTnI及NT-proBNP水平。结果2组cTnI峰值均于6 h出现,随后逐渐下降,除8天外其余各时间点封堵组cTnI水平均低于体外循环组(P<0.05);封堵组、体外循环组NT-proBNP峰值分别出现于12、24 h,随后逐渐下降,在6、12、24 h,2天,封堵组NT-proBNP水平均低于体外循环组(P<0.05)。结论与体外循环修补术相比,经胸小切口封堵术心脏损伤均较小;与NT-proBNP相比,cTnI对2种术式心脏损伤差异的反映出现较早且较敏感。

       

      Abstract: ObjectiveTo compare the levels of cardiactroponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) before and after perventricular device closure (PDC) or cardiopulmonary bypass (CPB) in patients with ventricular septal defect (VSD), and discuss the characteristics of cTnI and NT-proBNP to reflect cardiac injury, and the advantages of PDC through VSD. MethodsA total of 52 child patients with VSD who were suitable for PDC after evaluation by thoracic echocardiography. Then, 32 child patients received PDC, while another 20 received CPB. The levels of serum cTnI and NT-proBNP were detected immediately, 6 h, 12 h, 24 h, and 2 d, 4 d, and 8 d after operation. ResultsThe levels of cTnI in the two groups reached the peak 6 h after operation, which were then gradually decreased. The PDC group showed lower levels of cTnI than the CPB group at all time points except 8 days after operation (P<0.05). The levels of NT-proBNP reached the peak at 24 h for the PDC group and 12 h for the CPB group after operation, and were then gradually decreased. The PDC group showed lower levels of NT-proBNP than the CPB group at 6 h, 12 h, 24 h, and 2 d after operation (P<0.05). ConclusionsCompared with CPB, less cardiac damage is found in VSD patients after PDC. Compared with NT-proBNP, cTnI is more sensitive to evaluate cardiac damage.

       

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