Stewart J M, Gewitz M H, Woolf P K, Niguidula F, Fish B G, Zeballos G A
Department of Pediatrics, New York Medical College, Westchester Medical Center, Valhalla 10595, USA.
J Thorac Cardiovasc Surg. 1995 Oct;110(4 Pt 1):900-8. doi: 10.1016/s0022-5223(05)80156-4.
Impairment of humoral and neural regulation of blood pressure may contribute to preoperative and postoperative hypertension in coarctation of the aorta and may also affect the release of vasopressin and atrial natriuretic factor. Because vasopressin and atrial natriuretic factor have potent vasoactive effects, we measured plasma vasopressin and atrial natriuretic factor levels by radioimmunoassay before operation and for 5 days after operation in 11 patients aged 9 months to 12 years undergoing coarctation repair and in 12 control patients undergoing other cardiovascular operations. Six patients in the coarctation group required minimal antihypertensive therapy (group I) and five required prolonged intravenous antihypertensive therapy (group II). Before operation, vasopressin levels correlated with systolic blood pressure for all patients in the coarctation group (r = 0.83, p < 0.01) whereas atrial natriuretic factor levels did not. Before operation, atrial natriuretic factor levels were lower (28 +/- 5 vs 41 +/- 7 and 50 +/- 8 pg/ml, p < 0.05) and vasopressin levels were higher (28 +/- 6 vs 5.4 +/- 0.9 and 7 +/- 3 pg/ml, p < 0.05) in group II than in group I or control patients. Vasopressin levels were higher (p < 0.05) on the day of operation and on postoperative days 2 through 5 in group II than in group I and in control patients. Atrial natriuretic factor levels were lower during the day of operation in group II than in group I or in control patients (26 +/- 7 vs 51 +/- 16 and 50 +/- 7 pg/ml, p < 0.05) and remained lower than control values on postoperative days 1 and 3 through 5. Elevated vasopressin and lowered atrial natriuretic factor levels may contribute to preoperative and postoperative hypertension in coarctation.
体液和神经对血压调节的损害可能导致主动脉缩窄患者术前和术后高血压，也可能影响血管加压素和心房利钠因子的释放。由于血管加压素和心房利钠因子具有强大的血管活性作用，我们通过放射免疫分析法测量了11例年龄在9个月至12岁接受主动脉缩窄修复手术的患者术前及术后5天的血浆血管加压素和心房利钠因子水平，并与12例接受其他心血管手术的对照患者进行比较。主动脉缩窄组中有6例患者仅需少量降压治疗（I组），5例患者需要长期静脉降压治疗（II组）。术前，主动脉缩窄组所有患者的血管加压素水平与收缩压相关（r = 0.83，p < 0.01），而心房利钠因子水平则无相关性。术前，II组的心房利钠因子水平低于I组和对照患者（28±5 vs 41±7和50±8 pg/ml，p < 0.05），血管加压素水平高于I组和对照患者（28±6 vs 5.4±0.9和7±3 pg/ml，p < 0.05）。II组患者在手术当天及术后第2至5天的血管加压素水平高于I组和对照患者（p < 0.05）。II组患者在手术当天的心房利钠因子水平低于I组或对照患者（26±7 vs 51±16和50±7 pg/ml，p < 0.05），且在术后第1天及第3至5天仍低于对照值。血管加压素水平升高和心房利钠因子水平降低可能导致主动脉缩窄患者术前和术后高血压。
