Berry J G, Askovich B, Shaddy R E, Hawkins J A, Cowley C G
Complex Care Service, Department of Medicine, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
Pediatr Cardiol. 2008 Jan;29(1):70-5. doi: 10.1007/s00246-007-9012-3. Epub 2007 Aug 4.
The objective of this prospective study was to assess the prognostic role of perioperative B-type natriuretic peptide (BNP) levels in infants and children with single-ventricle congenital heart disease undergoing Norwood, bidirectional cavopulmonary anastomosis (BCPA), or Fontan operation. BNP levels were measured at baseline, after cardiopulmonary bypass, 6 to 12 hours after surgery, and then daily until indwelling vascular catheters were removed. Outcome measures included length of mechanical ventilation, inotropic support, and hospital stay. Twenty subjects underwent 23 surgical procedures (13 Norwood, 5 BCPA, and 5 Fontan). BNP levels were significantly higher in patients undergoing a Norwood procedure compared with a BCPA or Fontan procedure (p < 0.01). BNP levels measured 6 to 12 hours after surgery were predictive of duration of hospitalization (p = 0.005) and inotropic support (p = 0.01). An increase in BNP level within 48 hours of extubation was observed in 92% of patients undergoing a Norwood procedure. Early postoperative BNP levels correlate significantly with the ensuing duration of inotropic support and length of hospitalization. An increase in BNP after extubation may be reflective of the degree of underlying cardiopulmonary instability. Further investigation is necessary to define this important relation.
这项前瞻性研究的目的是评估围手术期B型利钠肽（BNP）水平在接受诺伍德手术、双向腔肺吻合术（BCPA）或Fontan手术的单心室先天性心脏病婴幼儿中的预后作用。在基线、体外循环后、术后6至12小时测量BNP水平，然后每天测量，直至拔除留置血管导管。观察指标包括机械通气时间、血管活性药物支持时间和住院时间。20名受试者接受了23次手术（13次诺伍德手术、5次BCPA手术和5次Fontan手术）。与接受BCPA或Fontan手术的患者相比，接受诺伍德手术的患者BNP水平显著更高（p<0.01）。术后6至12小时测量的BNP水平可预测住院时间（p = 0.005）和血管活性药物支持时间（p = 0.01）。92%接受诺伍德手术的患者在拔管后48小时内观察到BNP水平升高。术后早期BNP水平与随后的血管活性药物支持时间和住院时间显著相关。拔管后BNP升高可能反映了潜在心肺不稳定的程度。有必要进一步研究来明确这一重要关系。
