Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan.
J Am Coll Cardiol. 2010 Apr 27;55(17):1844-51. doi: 10.1016/j.jacc.2009.11.085.
Continuous low-dose infusion of human atrial natriuretic peptide (hANP) in patients undergoing cardiac surgery on cardiopulmonary bypass (CPB) inhibits the renin-angiotensin-aldosterone system and compensates for the adverse effects of CPB.
We examined the influence of hANP infusion on cardiac and renal function in patients with left ventricular dysfunction undergoing coronary artery bypass grafting (CABG).
The subjects were 133 patients who underwent CABG and had a pre-operative ejection fraction < or =35%. They were randomized to receive 0.02 microg/kg/min of hANP from the initiation of CPB (hANP group) or placebo (saline) infusion.
Early post-operative mortality did not show a significant difference between the 2 groups, but perioperative complications were significantly less frequent in the hANP group (p = 0.015). Long-term all-cause mortality showed no difference, but the cardiac death-free rate at 5 or 8 years post-operatively was 98.5% in the hANP group and 85.5% in the placebo group (p = 0.0285). Post-operative ejection fraction was significantly larger and the post-operative brain natriuretic peptide level was significantly lower in the hANP group. Serum creatinine was significantly lower in the hANP group than the placebo group at 1 month, 6 months, and 1 year post-operatively, whereas the estimated glomerular filtration rate was significantly higher in the hANP group at these times.
In patients with left ventricular dysfunction undergoing CABG, hANP showed renal- and cardio-protective effects and reduced post-operative complications. It also improved the long-term prognosis. We suggest that hANP should be considered as part of perioperative management of patients with cardiac dysfunction undergoing cardiac surgery. (NU-HIT trial for LVD; UMIN000001652).
在体外循环（CPB）心脏手术的患者中持续小剂量输注人心房利钠肽（hANP）可抑制肾素-血管紧张素-醛固酮系统并补偿 CPB 的不良影响。
我们研究了 hANP 输注对左心室功能障碍行冠状动脉旁路移植术（CABG）患者心脏和肾功能的影响。
受试者为 133 例行 CABG 且术前射血分数≤35%的患者。他们被随机分为接受 CPB 开始时输注 0.02μg/kg/min hANP（hANP 组）或安慰剂（盐水）输注（对照组）。
两组术后早期死亡率无显著差异，但 hANP 组围手术期并发症明显较少（p=0.015）。长期全因死亡率无差异，但 hANP 组术后 5 年和 8 年的无心脏死亡率为 98.5%，而对照组为 85.5%（p=0.0285）。术后射血分数明显增大，hANP 组术后脑利钠肽水平明显降低。hANP 组术后 1 个月、6 个月和 1 年的血清肌酐明显低于对照组，而 hANP 组肾小球滤过率明显高于对照组。
在左心室功能障碍行 CABG 的患者中，hANP 显示出肾和心脏保护作用，减少了术后并发症。它还改善了长期预后。我们建议 hANP 应被视为心脏手术合并心脏功能障碍患者围手术期管理的一部分。（NU-HIT 试验 for LVD；UMIN000001652）。
