脑钠肽是心脏手术预后的良好预测指标。

Brain natriuretic peptide is a good predictor for outcome in cardiac surgery.

作者信息

Elíasdóttir S B, Klemenzson G, Torfason B, Valsson F

机构信息

Faculty of Medicine, University of Iceland, Reykjavik, Iceland.

出版信息

Acta Anaesthesiol Scand. 2008 Feb;52(2):182-7. doi: 10.1111/j.1399-6576.2007.01451.x. Epub 2007 Oct 19.

DOI:10.1111/j.1399-6576.2007.01451.x

PMID:17949462

Abstract

BACKGROUND AND AIM

The heart secretes brain natriuretic peptide (BNP) in response to myocardial stretch. The aim of this study was to determine whether adverse effects after cardiac surgery were associated with higher serum BNP levels pre-operatively.

METHODS

One hundred and thirty-five patients undergoing various cardiac procedures were included in the study, and N-terminal pro-BNP (NT-pro-BNP) was measured pre-operatively. Post-operative complications were defined as follows: (i) a post-operative length of stay in the intensive care unit (ICU) exceeding 48 h; (ii) mortality at 28 days; (iii) the need for inotropic agents and/or intra-aortic balloon pump (IABP); and (iv) renal failure. Serum NT-pro-BNP values were compared for patients with and without complications. The serum NT-pro-BNP level was also correlated with the euroSCORE and ejection fraction (EF).

RESULTS

Pre-operative serum NT-pro-BNP levels were significantly higher in patients with an ICU length of stay of more than 2 days or death prior to post-operative day 28 (3118 ng/l vs. 705 ng/l; P < 0.001). Pre-operative serum NT-pro-BNP levels were also significantly higher in patients needing inotropic agents (2628 ng/l vs. 548 ng/l; P < 0.001) or IABP insertion (3705 ng/l vs. 935 ng/l; P = 0.001) or developing renal failure (2857 ng/l vs. 945 ng/l; P < 0.001) post-operatively. The correlation between the serum NT-pro-BNP level and euroSCORE was good (r = 0.658; P < 0.001). The receiver operating characteristic (ROC) curves were used to assess the ability of serum NT-pro-BNP, euroSCORE and EF to predict outcome after cardiac surgery. This revealed an area under the ROC curve for the length of stay in the ICU or mortality at 28 days of 0.829 for serum NT-pro-BNP, 0.814 for euroSCORE and 0.328 for EF assessed by transesophageal echocardiography, indicating that the pre-operative serum NT-pro-BNP level is a good prognostic indicator for outcome after cardiac surgery.

CONCLUSION

Serum NT-pro-BNP is a good predictor for complications after cardiac surgery, and is as good as euroSCORE and better than EF.

摘要

背景与目的

心脏会因心肌拉伸而分泌脑钠肽（BNP）。本研究的目的是确定心脏手术后的不良反应是否与术前较高的血清BNP水平相关。

方法

135例接受各种心脏手术的患者纳入本研究，并在术前测量N末端脑钠肽原（NT-pro-BNP）。术后并发症定义如下：（i）重症监护病房（ICU）术后住院时间超过48小时；（ii）28天死亡率；（iii）需要使用血管活性药物和/或主动脉内球囊反搏（IABP）；（iv）肾衰竭。比较有并发症和无并发症患者的血清NT-pro-BNP值。血清NT-pro-BNP水平还与欧洲心脏手术风险评估系统（euroSCORE）和射血分数（EF）相关。

结果

ICU住院时间超过2天或术后28天内死亡的患者术前血清NT-pro-BNP水平显著更高（3118 ng/l对705 ng/l；P<0.001）。术后需要血管活性药物（2628 ng/l对548 ng/l；P<0.001）或插入IABP（3705 ng/l对935 ng/l；P = 0.001）或发生肾衰竭（2857 ng/l对945 ng/l；P<0.001）的患者术前血清NT-pro-BNP水平也显著更高。血清NT-pro-BNP水平与euroSCORE之间的相关性良好（r = 0.658；P<0.001）。采用受试者工作特征（ROC）曲线评估血清NT-pro-BNP、euroSCORE和EF预测心脏手术后结局的能力。这显示，对于ICU住院时间或28天死亡率，血清NT-pro-BNP的ROC曲线下面积为0.829，euroSCORE为0.814，经食管超声心动图评估的EF为0.328，表明术前血清NT-pro-BNP水平是心脏手术后结局的良好预后指标。