The Significance Of Detection Of Plasma BNP Variations At Preoperative And Postoperative Undergoing Cardiorrhaphy

Objectives: through Dynamically measure the changes of bloodcirculating Brain natriuretic peptide (BNP) before and after congenital heartdisease repair or deformity correction surgery for children with congenitalheart disease, understanding the affect on cardiac function of repair surgery ordeformity correction surgery for congenital heart disease children, thus tograsp the information of postoperative cardiac function recovery of children intime, to early diagnose,early theatment the abnormal heart function ofchildren.Methods:1adopt prospective study mode,87children who wereconducted extracorporeal circulation thoracotomy under general anesthesiawith Cong-enital heart disease repair and deformity correction surgery in ourhospital dur-ing Mar.2010to Mar.2011were used as the experimentalsubjects,26healthy children who come out-patient clinic for medicalexamination were collect as the control at the same period.2they are dividedto three subset groups accor-ding to types of congenital heart diseas, atrialseptal defect group, ventricular septal defect group, tetralogy of Fallot group.record the gender, age, weight, therapy strategy, surgery name, post-surgerymedicine, and the time in hospital after surgery of the study subjects. Recordthe gender, age and weight of the control group as well.3preoperative BNPacquisition time in the day before surgery,2mL of venous blood was adoptdand put into EDTA anticoagulant tube for BNP measurement, mix, then, takethe standard amount of whole blood to detection the BNP value, as well asdetecting the levels of BNP at postoperative the first day, the2nd day and the7th day, into EDTA anticoagulant tubes save for testing, record values. TheBNP level of the control group was recorded during the day of physicalexamination. collecting the same way as before. BNP immunofluorescence dry quantitative method to determine the content.4SPSS13.0was used forstatistical analysis, Statistical tests are α=0.05for the test standards.Results：1General datathe indexes of age,weight,sex and the BNP levels at different timepoints both CHD group and control group are non-normal distribution(test ofnormality P<0.1),Median(inter-quartile range)(M(Q))was used to depict themeasurement data.1.1There are14cases of atrial septal defect (group1),63cases of ventricularseptal defect (group2),10cases of tetralogy of fallot (group3) in87cases ofcongenital heart disease patients. Among which there are56boys and31girlswith the ratio as1.8:1. age is2(4)years old, weight is12(8.5) kg.1.2The control group has26subjects, with16boys and10girls, the ratio is1.6:1. age is2.5(3)years old, weight is12.5(7) kg.1.3Both CHD and control groups,there is no statistical difference of BNPlevel with different ages, different genders, different weight between age,gender or weight(p>0.05). Preoperative age, gender, body weight among thethree groups was no significant difference (P>0.05)(Fig.1-Fig.2). The com-parison between the control group and CHD group, age, gender, body weightwas no difference (P>0.05)(Table1).1.4Before the surgery, the left ventricular ejection fraction by echocardio-graphy of all experimental children are larger than50%; the stay time of thesubjects in hospital after surgery is between5-9days, with average of7days,after the surgery; the routine use of milrinone to enhance myocardialcontractility is between1-5days with average of2days; the application ofdopamine to improve circulation is between2-5days with average of3days;digoxin, captopril, spironolactone,hydrochlorothiazide thiazide drugs wereconventional used by the patients at Post-surgery, to reach re-examinationpost-discharge.2results of Statistical analysis2.1Comparison of BNP between the experimental group at preoperative and control groupBefore surgery, the BNP level of the experimental group was10.30(40.7)pg/mL, the BNP of control group was6.95(14.4) pg/mL. To compare BNPlevel between the experimental group and control group,P=0.012, P <0.05,the difference have statistically significant. The preoperative BNP levels ofexperimental group is higher than the control group(Table2).2.2Comparison of preoperative BNP between3groups of the CHD groupBefore surgery, the BNP level of atrial septal defect group (group1),ventricular septal defect group (group2), tetralogy of Fallot group (group3),were16.05(40.7) pg/ml,12.40(47.1) pg/ml and7.45(33.6) pg/ml, respectively.group comparison of Preoperative BNP level between the three group,P=0.469>0.05, There is no statistical difference of BNP level among threegroups at Preoperative (Table3).2.3Comparison of interblock BNP of among3group of CHD at four timepoints2.3.1The BNP of the four time points in the atrial septal defect group(group1) is16.05(40.7) pg/ml,135.5(90) pg/ml,113(79) pg/ml,72.3(55)pg/ml, respectively; the BNP of the four time points in the ventricular septaldefect group (group2) is12.4(47.1)pg/ml,281(373)pg/ml,181(214)pg/ml,147(139)pg/ml, respectively；The BNP of the four time points in thetetralogy of Fallot group (group3) is7.45(33.6)pg/ml,312(572)pg/ml,436(554)pg/ml,289(531)pg/ml, respectivel;there is statistical differencefor the BNP levels of interblock Comparison at the4time points, with DF=2,F=5.414. P=0.006<0.05.2.3.2The BNP level of the3th group has the largest increase and slowest de-creease after surgery, the7th day of postoperative, it was still obviously higherthan the other two groups; while the first group has very little increase but ahuge decrease after surgery,the BNP numerus is minimum in the7th day ofpostoperative,the BNP level of group2in between(Fig.3).2.4Comparison of BNP level among different time pointsFor the CHD group, the BNP level was10.30(40.7) pg/ml before surgery. The BNP levels of the first day after surgery was266(330) pg/ml, the2nd dayand the7th day were175(213)pg/ml and141(148) pg/ml respecttively.2.4.1The comparison of BNP between postoperative3time points andpreoperativeCompared BNP between postoperative the first day and the preoperativehas Z=-7.830, P=0.000; between postoperative the2nd day and the preopera-tive has Z=-7.314, P=0.000; between postoperative the7th day and the preo-perative has Z=-7.174, P=0.000; above P<0.05, the contrast showed statisticalsignificance(Table4).2.4.2The comparison of BNP between postoperative3time points each otherComparison of BNP at postoperative3times points, the2nd day with thefirst day: Z=-4.230, P=0.000; the7th day with the first day: Z=-6.317,P=0.000; the7th day with the2nd day: Z=-4.378, P=0.000. all the P<0.05,showed statistically significant(Table4).2.4.3In general, BNP level is dynamically changing, reaches to its highestlevel on the first day after surgery, tends to decrease on the2nd day aftersurgery, keeps decreasing on the7th day after surgery, but still cannot reach tothe preoperative level (Fig.4).Conclusion：1There were no different of heart function index-blood circulating BNPamong the children of different types congenital heart disease, but the heartfunction other than the health children, it indicated that children withcongenital heart disease even if without heart failure performance, the heartfunction are worse than those of healthy children, it is not directly related to itsdeformans pathology type, while it is due to the disease itself exists abnormalhaemodynamics features.2Itself that the surgery treatment of congenital heart disease may cause sometransient damage to myocardial. To monitor the BNP change can earlyprevent, early diagnose and early treatment the Postoperative cardiacdysfunction of congenital heart disease.3Different pathological types of congenital heart disease, the post-surgery heart functions change were differently. Observe dynamic changes ofpostoperative BNP to guide the concrete application course of anti-heartfailure drug.4Until the7th day after surgery, the BNP remain did not revert topreoperative levels, it indicate that the heart function of children withcongenital heart disease still exist dysfunction, children need to long-termapplication cardiotonic drug take orally.