| Objective Brain natriuretic peptide(BNP) is a peptide hormones secreted major from ventricular myocytes,now finding it has important meanings to the diagnosis,treatment,prognosis of cardiovascular disease such as heart failure,left ventricular dysfunction,ischemic cardiomyopathy and hypertension,it also can relfect the developed status of these diseases.About the clinical significance of BNP in cardiovascular surgery are there many studies,but these were not clear enough.Especially as to the studying for N-terminal brain natriuretic peptide(NT-BNP) in different cardiac operation reported rarely.the prupose of this study was to assess the early postoperative risk in patients with rhermatic heart disease through perioperative plasma NT-BNP concentration and make up for the studying of NT-BNP.1.To investigate the perioperative changes of serum N-terminal pro-brain natriuretic peptide(NT-proBNP) concentration in patient with rheumatic valve disease undergoing cardiac valve repalcement and the reason of the changes.2.To study the meaning of perioperative serum concentration of NT-proBNP in the perioperative risk assessment of rheumatic valve disease.3.to find a important,satisfactory,and effective indicator to predict the perioperative risk of cardiac surgery especially in rheumatic valvular surgury.Methods There are 41 patients accord with conditions acmitted to the study,the serum NT-proBNP conentration was measured before cardiac surgery,3 h(hours),24h, 48h,and 120h after surgery.The cardiac output(CO),cardiac index(CI) before cardiac surgery and 16h afer sugery was measured by transesophageal echo-doppler,then stdudy on their relationship between the NT-proBNP concentration(before surgery).All patients were divided by death,arrhythmia,orgnic dysfunction,inotropic agents-using times,respirator-assisting times respectively,then compare the serum NT-proBNP concentration before operation in all groups.Results 1.The postoperative NT-proBNP level had no remarkable change 2 hours after operation(P＞0.05),but elevated markedly and acutely to a peak level at 24h after operation(P＜0.01),then it reduced remarkable at 48h and 120h after operation but still higher than its orininal level before operation(P＜0.01).2.NT-proBNP level before operation were significantly negatively correlated with CO before operation(r=-0. 8734,t=-11.2022,P＜0.01) and 16h after operation(r=-0.8579,t=-10.4291,P＜0.01),.It is also significantly negatively correlated with CI before operation(r=-0.8481, t=-9.9969,P＜0.01) and 16h after operation(r=-0.7691,t=-7.5148,P＜0.01).3,the groups with no death(t=3.6522,P＜0.01),no arrhymia(t=6.7322,P＜0.01),no important orgnic dysfunction(t=8.2082,P＜0.01 ),no severe complication (t=9.6524,P＜0.01) and a shorter inotropic agents-using times(t=11.4476, P＜0.01) and a shorter respirator-assist ing times in ICU(intensive care unit) (F=47.57,P＜0.01) were have a lower serum NT-proBNP level before operation, all statistic results is P＜0.01.Conlnsion The perioperative serum NT-proBNP level have a important clinical significance in assessment of perioperative risk in patients with rheumatic valve disease undergoing valvular replacement.serum NT-proBNP level sharply elevates in the early 24h after operation and then gradually decreases in the late time.In this study,we found the plasma NT-proBNP levels was negatively correlated with CO and CI at 16h and 48h after valvular operation in patients with rheumatic heart disease.after operation,the more higer plasma levels of NT-proBNP,the more lower value of CO and CI.so monitor the plasma levels of NT-proBNP after operation would be useful to assess the cardiac function,this enhancing its status as a biochemical indicator to measure the cardiac funtion.This study prove the monitor of plasma NT-proBNP levels have important meaning to assess the perioperative risk of rheumatic heart disease.so it should be give more attention to NT-proBNP because of its clinical function as a important biochemical indicator.but the number of sample in this group was small,the correlation of NT-proBNP and postoperative risk in other cardiac surgery is still not clear,the further clinnical study is still need.
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