Maeda T, Kitamura M, Kawai A, Hachida M, Aomi S, Endo M, Koyanagi H, Sakomura Y, Matsuda N, Kasanori H
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Jpn J Thorac Cardiovasc Surg. 1998 Dec;46(12):1297-304. doi: 10.1007/BF03217919.
The effect of hANP (atrial natriuretic peptide) was investigated clinically in 40 patients who underwent isolated valve replacement. Patients were divided into four groups: aortic regurgitation (AR), aortic stenosis (AS), mitral regurgitation (MR) and mitral stenosis (MS). Each group was divided into two subgroups: one was administered hANP after the operation until leaving ICU, and the other was not administered hANP. We measured the levels of hANP and c-GMP and blood pressure, pulmonary artery pressure, central venous pressure and levels of Na, K of urine and blood prcoperatively, immediately postoperatively and 1, 2, 4, 6 hours after operation. First, to examine the relationship between preoperative level of hANP and cardiac function, the relationship between preoperative level of hANP and history of cardiac failure and pulmonary artery wedge pressure (PAWP) were evaluated. Also, we evaluated the relationship between preoperative level of hANP and each dimension on echocardiography. There was a weak statistical relationship between hANP and PAWP (row = 0.39 (p = 0.04) Pearson correlation method) and there was no statistical relationship between hANP and duration of cardiac failure (row = 0.00445 (p = 0.98) Pearson correlation method). Preoperatively Left atrial diameter (LAD) showed a statistical relationship with level of hANP in every group using Spearman correlation method. Other dimensions such as left ventricular diastolic diameter (LVDd) and left ventricular systolic diameter (LVDs) and also fractional shortening (FS) did not show a strong correlation with preoperative level of hANP. Especially, in AS group there was a strong relationship between every dimension and preoperative level of hANP. Only in MS group LAD and the level of hANP were negatively related. This finding suggests that atrial dilatation results in reduction of secretion of hANP in cases of MS on long term follow up. Finally, hNAP therapy was shown to have a continuous diuretic effect, with stable hemodynamics.
对40例接受单纯瓣膜置换术的患者进行了人心房钠尿肽（hANP）临床疗效研究。患者分为四组：主动脉瓣反流（AR）、主动脉瓣狭窄（AS）、二尖瓣反流（MR）和二尖瓣狭窄（MS）。每组再分为两个亚组：一组术后给予hANP直至离开重症监护病房（ICU），另一组未给予hANP。我们在术前、术后即刻以及术后1、2、4、6小时测量了hANP和环磷酸鸟苷（c-GMP）水平以及血压、肺动脉压、中心静脉压和尿及血中钠、钾水平。首先，为研究术前hANP水平与心功能的关系，评估了术前hANP水平与心力衰竭病史及肺动脉楔压（PAWP）的关系。此外，我们还评估了术前hANP水平与超声心动图各维度之间的关系。hANP与PAWP之间存在微弱的统计学关系（Pearson相关法，r = 0.39（p = 0.04）），hANP与心力衰竭持续时间之间无统计学关系（Pearson相关法，r = 0.00445（p = 0.98））。术前使用Spearman相关法显示，每组的左心房直径（LAD）与hANP水平均存在统计学关系。左心室舒张直径（LVDd）、左心室收缩直径（LVDs）以及缩短分数（FS）等其他维度与术前hANP水平未显示出强相关性。尤其是在AS组，各维度与术前hANP水平之间存在很强的关系。仅在MS组，LAD与hANP水平呈负相关。这一发现表明，在MS患者的长期随访中，心房扩张导致hANP分泌减少。最后，结果显示hNAP治疗具有持续利尿作用，血流动力学稳定。
