Nakahara H
Department of Cardiovascular and Thoracic Surgery, Dokkyo University, Koshigaya Hospital, Saitama, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Apr;41(4):537-46.
Recent studies suggest that plasma levels of alpha-hANP may reflect the severity of heart failure, but mechanism whereby ANP secretion increase is not known. Changes in alpha-hANP concentration in the arterial (A-ANP) and coronary sinus blood (CS-ANP) during and after the cardiopulmonary bypass (CPB) were measured to investigate the role of ANP in patients undergoing cardiac surgery. Fifteen patients were divided into 2 group; Group I, valvular heart disease (n = 9), Group II, coronary artery disease (n = 6). Both A-ANP and CS-ANP were significantly higher in the Group I than Group II before and during CPB. The difference between two groups decreased and was insignificant after CPB. The CS-ANP was twice as high as A-ANP at simultaneous sampling point. Significant correlations between the changes in PCWP (delta PCWP) and delta A-ANP (p < 0.01), delta RAP and delta A-ANP (p < 0.02) and an inverse linear correlation between CI and A-ANP (p < 0.01) were observed. Not a significant correlation was found between ANP and urine volume, urinary sodium excretion and other renal functional parameters during and after CPB. Hypothermia and the use of mannitol in large quantities were considered to be factors. In the Group I, A-ANPs were also measured in the postoperative follow-up period. A-ANP remained elevated above 100 pg/ml in patients with poor and decreased below 100 pg/ml with good prognostic signs 3 to 6 months postoperatively. From these results, it is suggested that alpha hANP is secreted from the atrial wall to the coronary sinus vein and the levels of alpha-hANP in the perioperative and follow-up period after heart surgery, especially in the valvular heart disease, are considered to reflect the cardiac performance.
近期研究表明，血浆α - 人心房利钠肽（α - hANP）水平可能反映心力衰竭的严重程度，但ANP分泌增加的机制尚不清楚。为研究ANP在心脏手术患者中的作用，我们测量了体外循环（CPB）期间及术后动脉血（A - ANP）和冠状窦血（CS - ANP）中α - hANP浓度的变化。15例患者分为2组；I组，瓣膜性心脏病（n = 9），II组，冠状动脉疾病（n = 6）。在CPB前及CPB期间，I组的A - ANP和CS - ANP均显著高于II组。两组之间的差异在CPB后减小且无统计学意义。在同步采样点，CS - ANP是A - ANP的两倍。观察到肺毛细血管楔压变化（ΔPCWP）与ΔA - ANP之间存在显著相关性（p < 0.01），右心房压变化（ΔRAP）与ΔA - ANP之间存在显著相关性（p < 0.02），心指数（CI）与A - ANP之间存在负线性相关性（p < 0.01）。在CPB期间及术后，未发现ANP与尿量、尿钠排泄及其他肾功能参数之间存在显著相关性。低温和大量使用甘露醇被认为是相关因素。在I组中，还在术后随访期测量了A - ANP。术后3至6个月，预后不良的患者A - ANP持续高于100 pg/ml，预后良好的患者A - ANP降至100 pg/ml以下。从这些结果表明，α - hANP从心房壁分泌至冠状窦静脉，心脏手术后围手术期及随访期α - hANP水平，尤其是瓣膜性心脏病患者，被认为可反映心脏功能。
