Zierer A, Voeller R K, Melby S J, Kawa C B, Guthrie T J, Baumgartner M, Pasque M K, Moon M R, Moazami N
Division of Cardiovascular Surgery, Washington University School of Medicine, Barnes Jewish Hospital, Saint Louis, Missouri 62236, USA.
Transplant Proc. 2006 Dec;38(10):3680-4. doi: 10.1016/j.transproceed.2006.10.177.
Recombinant BNP (nesiritide) is known to reduce endothelin levels, cause afferent arteriole vasodilation, and increase natriuresis and diuresis. We hypothesized that intraoperative infusion of BNP may benefit renal function in cardiac transplant patients.
From June 2003 to September 2005, 22 consecutive heart transplant patients received BNP at a dose of 0.01 microg/kg/min before initiation of cardiopulmonary bypass (group A). BNP infusion was continued for a mean of 3.3 +/- 1.9 days. Hemodynamics, urine output, and serum creatinine levels were prospectively collected and compared with 22 consecutive patients who underwent heart transplantation between May 2002 and June 2003 following the identical transplant protocol, but without BNP infusion (group B).
At 24 hours postoperatively, mean blood pressure was comparable between groups (87 +/- 11 mm Hg vs 89 +/- 17 mm Hg, P = .7), but pulmonary artery pressure (18 +/- 5 mm Hg vs 24 +/- 5 mm Hg, P = .001) and central venous pressure (12 +/- 5 mm Hg vs 16 +/- 4 mm Hg, P = .01) were lower with BNP infusion, whereas cardiac index was augmented (2.8 +/- 0.5 vs 2.4 +/- 0.6, P = .03). Requirement of low-dose inotropic and vasopressor support was equally distributed between groups (P > or = .72). Postoperative urine output for the initial 24 hours was higher in group A (84 +/- 15 vs 55 +/- 36 mL/h, P = .01). None of the patients with BNP infusion required additional diuretics or renal replacement therapy during the first week after transplantation. Mean postoperative serum creatinine levels as compared with preoperative values remained unchanged within group A (P = .12), but increased significantly in group B (P < .001).
Intraoperative BNP infusion in heart transplant recipients was associated with favorable postoperative hemodynamics, significantly improved urine output, and stable serum creatinine levels. A prospective, randomized, multicenter trial is warranted to evaluate the potential renal protective benefits of intraoperative BNP infusion in this patient population.
已知重组脑钠肽（奈西立肽）可降低内皮素水平，引起入球小动脉血管舒张，并增加尿钠排泄和利尿作用。我们推测术中输注脑钠肽可能对心脏移植患者的肾功能有益。
2003年6月至2005年9月，22例连续心脏移植患者在体外循环开始前接受剂量为0.01微克/千克/分钟的脑钠肽输注（A组）。脑钠肽输注平均持续3.3±1.9天。前瞻性收集血流动力学、尿量和血清肌酐水平，并与2002年5月至2003年6月间按照相同移植方案接受心脏移植但未输注脑钠肽的22例连续患者（B组）进行比较。
术后24小时，两组间平均血压相当（87±11毫米汞柱对89±17毫米汞柱，P = 0.7），但输注脑钠肽组肺动脉压（18±5毫米汞柱对24±5毫米汞柱，P = 0.001）和中心静脉压（12±5毫米汞柱对16±4毫米汞柱，P = 0.01）较低，而心脏指数增加（2.8±0.5对2.4±0.6，P = 0.03）。低剂量血管活性药物支持的需求在两组间分布相同（P≥0.72）。A组术后最初24小时尿量较高（84±15对55±36毫升/小时，P = 0.01）。输注脑钠肽的患者在移植后第一周内均无需额外使用利尿剂或肾脏替代治疗。A组术后平均血清肌酐水平与术前值相比无变化（P = 0.12），但B组显著升高（P<0.001）。
心脏移植受者术中输注脑钠肽与术后良好的血流动力学、显著改善的尿量和稳定的血清肌酐水平相关。有必要进行一项前瞻性、随机、多中心试验，以评估术中输注脑钠肽对该患者群体潜在的肾脏保护益处。
