平均动脉压变异率对老年下肢骨折内固定术中N-端脑利钠肽前体及超敏C反应蛋白的影响
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摘要
目的探讨老年下肢骨折内固定术中平均动脉压变异率对血清N-端脑利钠肽前体(NT-proBNP)及超敏C反应蛋白(hs-CRP)水平的影响。方法将180例老年下肢骨折开放复位内固定手术患者根据其术前自身合并症分为3组(冠心病组、脑梗死组、冠心病合并脑梗死组),分别观察基础平均动脉压、平均动脉压下降5%、10%及20%时血清NT-proBNP及hs-CRP的变化,分析其相关性。结果血清NT-proBNP及hs-CRP随平均动脉压的下降而升高,当平均动脉压下降超过20%时升高最为显著。结论平均动脉压的变化能反映患者NT-proBNP及hs-CRP指标变化水平,并以此预示术中发生心脑血管意外的可能性。
Objective To observe the mean arterial pressure variability of serum N-terminal brain natriuretic peptide precursor( NT-proBNP) and high-sensitivity C-reactive protein( hs-CRP)levels during internal fixation of lower limb fractures in the elderly patients. Methods A total of 180 elderly patients with open reduction and internal fixation of lower extremity fractures were divided into three groups( coronary heart disease group,cerebral infarction group,coronary heart disease combined with cerebral infarction group). The changes of NT-proBNP and hs-CRP in serum were observed when basal mean arterial pressure,mean arterial pressure decreased by 5%,10% and 20%,respectively,and their correlation was analyzed. Results Serum NT-proBNP and hs-CRP increased with the decrease of mean arterial pressure,especially when the mean arterial pressure decreased more than 20%. Conclusion The change of mean arterial pressure can reflect the changes of NTproBNP and hs-CRP in patients,which indicates that the significantlyincreased possibility of cardiocerebrovascular accident during operation.
Objective To observe the mean arterial pressure variability of serum N-terminal brain natriuretic peptide precursor( NT-proBNP) and high-sensitivity C-reactive protein( hs-CRP)levels during internal fixation of lower limb fractures in the elderly patients. Methods A total of 180 elderly patients with open reduction and internal fixation of lower extremity fractures were divided into three groups( coronary heart disease group,cerebral infarction group,coronary heart disease combined with cerebral infarction group). The changes of NT-proBNP and hs-CRP in serum were observed when basal mean arterial pressure,mean arterial pressure decreased by 5%,10% and 20%,respectively,and their correlation was analyzed. Results Serum NT-proBNP and hs-CRP increased with the decrease of mean arterial pressure,especially when the mean arterial pressure decreased more than 20%. Conclusion The change of mean arterial pressure can reflect the changes of NTproBNP and hs-CRP in patients,which indicates that the significantlyincreased possibility of cardiocerebrovascular accident during operation.
引文
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[15]徐文新.血清B型脑利钠肽、超敏C反应蛋白在不同分级心力衰竭患者中的检测价值[J].中国现代药物应用,2013,7(1):11-12.
[2]向登国,田华.血浆BNP浓度在老年患者麻醉风险体系评估中的临床意义[J].中国医药导刊,2011,13(12):2039-2040.
[3] Lin J,Zheng D L,Li T F. Correlations between plasma concentration of brain natriuretic peptide and cardiac function in patients with heart failure[J]. Journal of Clinical Cardiology,2001,17(10):454-455.
[4] Loran D B,Hyde B R,Zwischenberger J B. Perioperative management of special populations:the geriatric patient[J].Surg Clin North Am,2005,85(6):1259-1266.
[5]古妙宁,陈仲清.临床急诊麻醉与复苏学[M].北京:科学技术文献出版社,2009:409-409.
[6]冉红,张凤林,梁韶军.老年患者麻醉前血浆B型脑尿钠肽浓度与麻醉ASA病情评估分级相关性临床研究[J].陕西医学杂志,2010,39(11):1483-1484.
[7] Nishikimi T,Maeda N,Matsuoka H. The role of natriuretic peptides in cardioprotection[J]. Cardiovasc Res,2006,69(2):318-328.
[8]中华神经科学会.各类脑血管疾病诊断要点[J].中华神经学杂志,1996,29(6):378-380.
[9]魏世锦.超敏C反应蛋白与脑梗死病变的关系[J].中国医学创新,2010,7(21):145-146.
[10]李承,方芳.急性脑血管疾病患者超敏C-反应蛋白的含量变化及临床意义[J].中国急救医学,2017,37(z1):313-314.
[11]王小芳.超敏C反应蛋白测定在临床上的应用[J].中国医学创新,2009,6(30):94-95.
[12]程庆荣,李结华,唐海沁.高龄冠心病患者脑钠肽、D-二聚体、超敏C反应蛋白变化的意义[J].中国老年学杂志,2011,31(23):4524-4526.
[13]胡维信,邱文奎,苏振炎,等.高龄髋部骨折患者围手术期死亡的危险因素分析[J].辽宁医学杂志,2017,31(1):11-13.
[14]冯曼玲.血浆脑利钠肽和超敏C反应蛋白对急性缺血性脑卒中患者预后的评估价值[J].标记免疫分析与临床,2015,22(3):164-166.
[15]徐文新.血清B型脑利钠肽、超敏C反应蛋白在不同分级心力衰竭患者中的检测价值[J].中国现代药物应用,2013,7(1):11-12.