| Objective: To discuss the change of B-brain natriuretic peptide in patients with left-right shunt congenital heart defect at high altitude and the relationship between pulmonary pressure。Methods: To select134 patients with congenital heart disease in the armed police general hospital from April 2013 to February 2015, divide the patients into two groups according altitude, 56 Tibet cases with congenital heart disease higher than 3500 meters were high altitude group, 78 cases of Inner Mongolia and other places of congenital heart disease less than 250 meters were low altitude group, 15 cases Tibet school-age children were control group, draw venous blood 3 ml in the morning before breakfast for b-type brain natriuretic peptide examination to observe the differences between them;To choose 97 patients who did intervention treatment, high altitude cases were group A,low altitude cases were group B,control cases were group C,compare the preoperative and postoperative 1 day, 3 days b-type brain natriuretic peptide and preoperative and postoperative mean pulmonary pressure, left ventricular diastolic diameter and ejection fraction, then calculate Qp/Qs, according disease to analysis the correlation between BNP and m PAP or Qp/Qs。Consequences: The preoperative BNP value of high altitude group was 176.3 ±15.3 pg/ml, low altitude group was 150.2±13.2pg/ml, control group was 5.6±2.4 pg/ml, the difference of three groups were significant by using ANOVA(p < 0.05), there was no significant difference after comparing high altitude group and low altitude group(p > 0.05), but high altitude group and low altitude group or high altitude group withcontrol group was significantly statistical difference(p < 0.001);preoperative LVEDD value of high altitude group was 39.1±3.0 mm, low altitude group was 39.9 ±2.8 mm, control group was 36.5±3.4 mm, after the analysis of variance to know the difference between the three groups(p < 0.05),there was no significant difference between high altitude group and low altitude group by ANOVA(p > 0.05), but high altitude group and control group or low altitude group with control group was statistically significant(p < 0.05);the Preoperative LVEF value of high altitude group was 66.0 ± 4.5%, low altitude group was 64.5±3.8%, control group was 66.5 ±2.7%, but the three groups was no significant statistical difference(p > 0.05), the preoperative BNP value of group A was 175.0±14.8pg/ml, the BNP value of postoperative one day was 210.3±10.8 pg/ml,the value of three days after intervention was 30.5±2.4pg/ml, different time points using the ANOVA of repeated measurement of BNP was statistically difference(p < 0.05), the BNP of preoperative and postoperative one day was statistically significant(p < 0.05), the BNP of preoperative and postoperative three days was statistically significant(p < 0.05), compared postoperative one day with three days after intervention was statistically significant(p < 0.05); the preoperative BNP value of Group B was 146.1 ±11.5 pg/ml, the BNP value of postoperative one day was 182.4 ±12.5 pg/ml, the BNP value of three days after intervention was 22.6±5.3 pg/ml, the BNP between preoperative and postoperative one day was statistically significant(p < 0.05), the BNP between preoperative and postoperative three days was statistically significant(p < 0.05), postoperative one day compared with three days after operation was statistically significant(p < 0.05);But using independent sample T test analysis BNP for A, B two groups at the same time was no significant statistical difference(p > 0.05), the value of preoperative pulmonary mean pressure in group A was 33.5±3.2 mm Hg, the postoperative pulmonary artery mean pressure value was 18.2±4.6 mm Hg, the difference between them was statistically significant(p < 0.05), the preoperativepulmonary artery mean pressure value in group B was 32.9±3.0 mm Hg, the postoperative pulmonary artery mean pressure value was 17.1±3.7 mm Hg, the difference between them was statistically significant(p < 0.05), preoperative group A with group B was no statistical difference(p > 0.05), group A and group B after intervention was no statistical difference(p > 0.05),the value of preoperative LVEDD in group A was 39.3±3.2 mm, the value of postoperative LVEDD was 35.5±2.8 mm, the difference between them were statistically significant(p < 0.05), the value of preoperative LVEF was 66.3±4.3%, the value of postoperative LVEF was 57.3± 2.3%, the difference between them was significant(p < 0.05); the value of preoperative LVEDD in Group B was 39.5±2.6 mm, the value of postoperative LVEDD was 36.3 ±2.5mm, the difference between them was statistically difference(p < 0.05), the value of preoperative LVEF was 64.3±3.5%, the value of postoperative LVEF 59.5 ±3.1%, the difference was statistically different(p < 0.05), the difference value of LVEF group A between preoperative with postoperative was 9.5±3.5%, group B was 5.1±3.4%, the difference was statistically significant(p < 0.05),between preoperative BNP with mean preoperative pulmonary artery pressure in group A was positive correlation, r = 0.634, p < 0.05, between preoperative BNP and Qp/Qs in group A was positive correlation, r = 0.756, p < 0.05; between preoperative BNP and preoperative pulmonary artery mean pressure in group B was a positive correlation,r = 0.593, p < 0.05,between preoperative BNP and Qp/Qs was a positive correlation,r = 0.728, p < 0.05,between BNP and preoperative pulmonary artery mean pressure in large PDA group was a positive correlation,,r = 0.502, p < 0.05;preoperative BNP is positively correlated with Qp/Qs, r = 0.485, p < 0.05;preoperative BNP and pulmonary artery mean pressure in no large group of PDA was a positive correlation,r = 0.483, p< 0.05,between preoperative BNP and Qp/Qs was a positive correlation,r = 0.368, p < 0.05,BNP and preoperative pulmonary artery mean pressure was a positive correlationin the large ASD group,r = 0.352, p < 0.05; preoperative BNP and Qp/Qs was a positive correlation in large ASD group,r = 0.247, p < 0.05;BNP and preoperative pulmonary artery mean pressure was a positive correlation in small and middle size ASD group,r = 0.257, p < 0.05;between preoperative BNP and Qp/Qs was a positive correlation,r = 0.215, p < 0.05。Conclusions: 1.There are different levels of BNP value in left-right shunt congenital heart disease patients, the EF values may already normal but the heart function was damaged.2. The BNP after intervention rises before gradually decline, so postoperative intervention should strengthen the supervision, control the occurrence of adverse events, can dynamically monitor the BNP values change when it was necessary.3. Large PDA shunt amount was enormous, can influence hemodynamic very much and prone to pulmonary hypertension, should be given active treatment.4. The EF value of high altitude areas with congenital heart disease fell more than low altitude at preoperation,should strengthen follow-up. 5.The BNP can be used in the pre-hospital of congenital heart disease screening, save medical resources, and can do teamwork well with echocardiography, improve the efficiency of screening. |
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