Hata M, Masato O, Cho S, Narata M, Hata H, Inoue T, Sezai Y
Department of Cardiovascular Surgery, Okaya Enrei Hospital, Nagano, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Nov;45(11):1797-802.
Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are homeostatic hormones secreted from the human heart which protect both cardiac and the renal function. It is well known that these hormones increase in patients along with increases in the severity of congestive heart failure or acute myocardial infarction. However, as yet there are no reports in the literature on changes of the secreted level of ANP or BNP in surgical patients undergoing cardiopulmonary bypass (CPB). We evaluated the relationship between ANP, BNP, and perioperative cardiac and renal functions in patients with heart failure caused by CPB. We selected 45 patients of elective open heart surgery. We measured plasma level of ANP in all 45 cases, and BNP in 18 cases at preoperation, postoperation, and postoperatively three days after, respectively. At the same time, the cardiac index (CI) was measured. These cases were divided into the following groups. Group A1 (n = 23): cases in which the preoperative ANP was less than 40 pg/ ml. Group A2 (n = 22): cases in which the preoperative ANP was more than 40. Group B1 (n = 8): cases in which the preoperative BNP is increased to the level of 5 times as mach as the normal level. Group B2 (n = 8): cases in which the preoperative BNP is increased to the level of 5 times as much as the normal level. Group B2 (n = 10): cases in which the preoperative BNP was more than that of 10 times as mach as normal level. We then carried out a comparative study of the perioperative cardiac and renal functions in group A1 and A2, and group B1 and B2, respectively. In the terms of preoperative cardiac and renal function, there were no significant differences between groups A1 and A2, and there were no significant differences in urinary volume during CPB or post operative CI. However, the urinary volume during CPB of group B1 was significantly more than that of B2. Furthermore, the incidence of postoperative CI in group B1. Furthermore, the incidence of postoperative CI in group B1 was significantly higher than in B2. The preoperative and post operative third day BNP level had significant negative correlations with postoperative CI and postoperative third day CI, respectively (r = -0.641, -0.514, p = 0.008, 0.012). The postoperative ANP and BNP levels tend to a mean level roughly similar to one another because of the easing of cardiac stress by surgery and postoperative management. According to these results and several instances in the literature, a preoperative high BNP is considered to suggest a potential perioperative risk for cardiac and renal function. We conclude that determination of the plasma BNP level can be helpful for decisions related to CPB flow and measures taken to enhance cardiac and renal protection during surgery, and therefore is a useful reference for perioperative management.
心房利钠肽（ANP）和脑利钠肽（BNP）是人体心脏分泌的稳态激素，可保护心脏和肾功能。众所周知，这些激素在充血性心力衰竭或急性心肌梗死患者中会随着病情严重程度的增加而升高。然而，目前尚无文献报道接受体外循环（CPB）手术的患者中ANP或BNP分泌水平的变化。我们评估了CPB所致心力衰竭患者中ANP、BNP与围手术期心脏和肾功能之间的关系。我们选择了45例择期心脏直视手术患者。分别在术前、术后及术后三天测量了所有45例患者的血浆ANP水平，以及18例患者的BNP水平。同时，测量了心脏指数（CI）。这些病例被分为以下几组。A1组（n = 23）：术前ANP小于40 pg/ml的病例。A2组（n = 22）：术前ANP大于40的病例。B1组（n = 8）：术前BNP升高至正常水平5倍的病例。B2组（n = 8）：术前BNP升高至正常水平5倍的病例。B2组（n = 10）：术前BNP大于正常水平10倍的病例。然后我们分别对A1组和A2组、B1组和B2组的围手术期心脏和肾功能进行了比较研究。在术前心脏和肾功能方面，A1组和A2组之间无显著差异，CPB期间或术后CI的尿量也无显著差异。然而，B1组CPB期间的尿量明显多于B2组。此外，B1组术后CI的发生率。此外，B1组术后CI的发生率明显高于B2组。术前和术后第三天的BNP水平分别与术后CI和术后第三天的CI呈显著负相关（r = -0.641，-0.514，p = 0.008，0.012）。由于手术和术后管理减轻了心脏压力，术后ANP和BNP水平趋于大致相似的平均水平。根据这些结果和文献中的几个实例，术前高BNP被认为提示心脏和肾功能存在潜在的围手术期风险。我们得出结论，测定血浆BNP水平有助于决定CPB流量以及采取措施加强术中心脏和肾脏保护，因此是围手术期管理的有用参考。
