Terazawa E, Dohi S, Akamastsu S, Ohata H, Shimonaka H
Department of Anaesthesiology and Critical Care Medicine, Gifu University School of Medicine, Tsukasamachi-40, Gifu City, Gifu 500-8705, Japan.
Anaesthesia. 2003 Mar;58(3):223-32. doi: 10.1046/j.1365-2044.2003.03037.x.
The initiation of cardiopulmonary bypass creates significant derangements in cardiovascular volume status and both endocrine and autonomic nervous system function. To examine whether such derangements might differ in patients with different pre-operative physical status scores, we measured the plasma concentrations of calcitonin gene-related peptide, atrial natriuretic peptide and brain natriuretic peptide, catecholamines and antidiuretic hormone, as well as haemodynamic variables, during and after cardiopulmonary bypass in 27 consecutive patients undergoing coronary artery bypass grafting. The pre-operative levels of atrial natriuretic peptide and brain natriuretic peptide differed significantly between ASA II patients and III and IV patients [mean (SD) brain natriuretic peptide levels = 14 (8.2) vs. 129 (51) pg.ml-1]. Plasma calcitonin gene-related peptide increased significantly in both groups after the initiation of cardiopulmonary bypass, and remained increased throughout cardiopulmonary bypass. The changes in plasma epinephrine, norepinephrine and antidiuretic hormone were similar to those reported previously. The changes in plasma calcitonin gene-related peptide, atrial natriuretic peptide and brain natriuretic peptide did not correlate with any changes in haemodynamic variables before or after cardiopulmonary bypass. Measurement of plasma brain natriuretic peptide might usefully be included in the pre-operative evaluation of patients with cardiac disease.
体外循环的启动会导致心血管容量状态以及内分泌和自主神经系统功能出现显著紊乱。为了研究这些紊乱在术前身体状况评分不同的患者中是否存在差异，我们对27例连续接受冠状动脉旁路移植术的患者在体外循环期间及之后测量了血浆降钙素基因相关肽、心房利钠肽和脑利钠肽、儿茶酚胺和抗利尿激素的浓度，以及血流动力学变量。ASA II级患者与III级和IV级患者术前的心房利钠肽和脑利钠肽水平存在显著差异[脑利钠肽水平的均值（标准差）= 14（8.2）对129（51）pg.ml-1]。体外循环启动后两组患者血浆降钙素基因相关肽均显著升高，且在整个体外循环过程中持续升高。血浆肾上腺素、去甲肾上腺素和抗利尿激素的变化与先前报道的相似。血浆降钙素基因相关肽、心房利钠肽和脑利钠肽的变化与体外循环前后的任何血流动力学变量变化均无相关性。血浆脑利钠肽的测量可能有助于纳入心脏病患者的术前评估。
