Pérez-Piaya Maríarosa, Abarca Elena, Soler Virginia, Coca Ana, Cruz Marta, Villagrá Fernando, Giannivelli Silvina, Asensio Angel
Department of Pediatrics, Madrid-Montepríncipe University Hospital, Avda. Montepríncipe n° 25, Boadilla del Monte, 28660 Madrid, Spain.
Interact Cardiovasc Thorac Surg. 2011 Mar;12(3):461-6. doi: 10.1510/icvts.2010.245803. Epub 2010 Dec 5.
To explore the value of N-terminal-pro-brain natriuretic peptide (NT-ProBNP) as a predictive biomarker of postoperative cardiovascular surgery.
A prospective study of 68 patients (0-15 years), submitted to open-heart surgery was conducted. NT-ProBNP and other biochemical and clinical markers were measured preoperatively and during the first 48 postoperative hours.
NT-ProBNP preoperative reduced one hour after surgery, increased significantly later, and remained without change between 12 hours and 48 hours postoperatively. Peak values (24 hours) were correlated with preoperative levels (R=0.73; P<0.001), risk adjustment congenital heart surgery-1 (R=0.37; P<0.002), length of cardiopulmonary bypass (CPB) (R=0.57; P<0.001); age (R=-0.55; P<0.001) and weight of patients (R=-0.46; P<0.001). Independent predictors of NT-ProBNP-peak were preoperative value (β=0.42) and CPB length (β=0.24; R(2) of model 0.63; P<0.001). The peak values were correlated to a maximum inotropic score (R=0.46; P<0.001), duration of inotropic therapy (R=0.44; P<0.001), duration of mechanical ventilation support (R=0.39; P<0.001) and length of stay in the Pediatric Intensive Care Unit (R=0.45; P<0.001). Independent predictors of enhanced intensive care unit stay, controlling by risk adjustment score, were high preoperative NT-ProBNP (OR 5.5, 95% CI 1.2-25.5), and high postoperative troponine (OR 10.5, 95% CI 2.2-49.2).
NT-ProBNP concentration is dependent on time during the perioperative period, it peaks at 24 hours and depends on the preoperative value and CPB length. A high peptide level before surgery is an independent predictor of prolonged stay in intensive pediatric care.
探讨N端前脑钠肽（NT-ProBNP）作为心血管手术后预测生物标志物的价值。
对68例（0 - 15岁）接受心脏直视手术的患者进行前瞻性研究。术前及术后48小时内测定NT-ProBNP及其他生化和临床指标。
NT-ProBNP术前水平在术后1小时降低，随后显著升高，在术后12小时至48小时之间保持不变。峰值（24小时）与术前水平相关（R = 0.73；P < 0.001）、风险调整先天性心脏病手术-1（R = 0.37；P < 0.002）、体外循环（CPB）时间（R = 0.57；P < 0.001）、年龄（R = -0.55；P < 0.001）和患者体重（R = -0.46；P < 0.001）。NT-ProBNP峰值的独立预测因素是术前值（β = 0.42）和CPB时间（β = 0.24；模型R(2)为0.63；P < 0.001）。峰值与最大正性肌力评分相关（R = 0.46；P < 0.001）、正性肌力治疗持续时间（R = 0.44；P < 0.001）、机械通气支持持续时间（R = 0.39；P < 0.001）和儿科重症监护病房住院时间（R = 0.45；P < 0.001）。在控制风险调整评分后，重症监护病房住院时间延长的独立预测因素是术前高NT-ProBNP（OR 5.5，95% CI 1.2 - 25.5）和术后高肌钙蛋白（OR 10.5，95% CI 2.2 - 49.2）。
NT-ProBNP浓度在围手术期依赖于时间，在24小时达到峰值，且取决于术前值和CPB时间。术前高肽水平是小儿重症监护病房延长住院时间的独立预测因素。
