成人房间隔缺损封堵术前后心脏功能变化及其与血浆脑钠肽水平的关系

摘要

目的：观察成人房间隔缺损（ASD）患者封堵术前后心脏功能变化，分析其与血浆脑钠肽（BNP）水平的关系。方法选择47例继发孔成人ASD患者，均于封堵术前1 d及术后72 h行超声心动检查测量ASD大小、心脏功能，ELISA法检测血浆BNP。结果与术前比较，患者术后72 h右心室舒张末期内径（ RVEDd）、右心房左右内径（RAD）、三尖瓣环收缩期位移（TAPSE）减小（P均＜0．01），而左心室舒张末期内径（LVEDd）、左心室舒张末期容积（LVEDV）、左心室每搏输出量（LVSV）、E／Em增加（P均＜0．01），血浆BNP升高（P＜0．01）。术前logBNP与患者年龄、ASD大小呈正相关（r分别为0．013、0．023，P均＜0．01），术后logBNP与术前RVEDd、ASD大小、术后1周的E／Em值呈正相关（r分别为0．012、0．019、0．024，P均＜0．05）。结论成人ASD患者封堵术后左心室收缩功能无明显变化，而左心室舒张功能受损；血浆BNP水平与左心室舒张功能有关，可作为LVEF正常的成人ASD患者左心室舒张功能不全预测指标，以进行预适应治疗，减少术后并发症。%Objective To observe the changes of cardiac function before and after transcatheter closure of atrial septal defect (ASD) in adults and the correlation between cardiac function and brain natriuretic peptide (BNP).Methods 47 adult ASD patients were enrolled.The diameter of ASD (Echcardiography), cardiac function and BNP in plasma (ELISA) were detected 1 day before occlusion and 72 hours after occlusion.Results Compared with pre-operation, RVEDd, 72 hours after transcatheter closure of RAD and TAPSE decreased significantly (all P<0.01), while LVEDd, LVEDV, LVSV and E/Em increased significantly (all P<0.01), BNP in plasma also increased significantly (P<0.01).Before transcathe-ter closure of logBNP was positively correlated with the size of ASD and the age of patients (both P<0.01).After tran-scatheter closure of logBNP was positively correlated with the size of ASD , RVEDd before operation , and E/Em 1 week af-ter the occlusion (all P<0.05).Conclusions Although there is no significant change in the left ventricular systolic func-tion, the left ventricular diastolic function damage often occurs transcatheter closure of ASD. BNP in plasma and the left ventricular diastolic function has positive correlation after the occlusion. BNP can be used as predictor of left ventricular di-astolic dysfunction in normal LVEF , in which preconditioning treatment is recommended before the occlusion to reduce postoperative complications.