血管紧张素转换酶抑制剂及β-受体阻滞剂对瓣膜置换术后患者神经内分泌激素水平的影响
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湖南省医药卫生科研计划课题(B2007102)


Effects of Angiotensin Converting Enzyme Inhibitors and β-receptor Blockers on Neuroendocrine Hormones in Patients after Valve Replacement
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    摘要:

    目的通过比较术后不同药物治疗组的神经内分泌激素水平的动态变化,了解血管紧张素转换酶抑制剂及β-受体阻滞剂对瓣膜置换术后神经内分泌激素水平的影响。方法60名患者随机分为A、B、C三个药物治疗组,分别于术前及术后不同时间测定患者血浆血管紧张素Ⅱ、心房利钠多肽及醛固酮水平。结果A组患者术后各时间段测定的血浆血管紧张素Ⅱ、心房利钠多肽及醛固酮浓度与术前相比均无明显差异。B组患者及C组患者与术前相比,术后血浆血管紧张素Ⅱ、心房利钠多肽及醛固酮浓度在不同时间段均有下降;C组与B组比较,两组患者术后血浆血管紧张素Ⅱ、醛固酮浓度的下降程度并无明显差别;血浆心房利钠多肽浓度的下降程度则有明显差异。结论瓣膜性心脏病患者行人工机械瓣膜置换术后予以常规强心、利尿治疗之外,辅以血管紧张素转换酶抑制剂和/或β-受体阻滞剂口服治疗可以更有效的降低患者神经内分泌激素水平。

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    Aim To compare the dynamic changes of neuroendocrine hormone levels on different treatment groups,in order to understand the angiotensin converting enzyme inhibitor and β-receptor blockers' effect on neuroendocrine hormone after valve replacement. Methods 60 patients were randomly divided into A,B,C groups,and were given different drugs after treatment.We took blood samples in the preoperative and different time of postoperation to determine plasma level of angiotensinⅡ,atrial natriuretic polypeptide,aldosterone. Results After valve replacement surgery,plasma angiotensinⅡ,atrial natriuretic polypeptide,aldosterone concentrations at all time measured compared with the preoperative levels had no significant differences in A group.But in B group and C group,compared with the preoperative and postoperative 1 week the plasma atrial natriuretic polypeptide concentrations had no significant change,plasma atrial natriuretic polypeptide concentrations measured in postoperative 2 weeks started to decline,plasma aldosterone concentrations started to decline until 4 weeks after operation;until postoperative 16 weeks the plasma angiotensinⅡ concentrations in B group had a significant decrease;and in C group the plasma angiotensinⅡ concentrations had significant decrease in 8 weeks after operation.Compared with B group and C group,the decreased level of plasma angiotensinⅡ,aldosterone concentrations after operation had no significant difference,but the decreased level of plasma atrial natriuretic polypeptide concentrations in C group was better than B group. Conclusion Patients after mechanical heart valve replacement surgery with routine cardiocinetic,diuretic therapy,and in addition supplemented angiotensin converting enzyme inhibitor and/or β-blocker treatment can effectively reduce the neuroendocrine hormone levels.

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冯耀光,胡建国,朱德胜,王元星,贺大璞,韦兵,聂军,龙超众.血管紧张素转换酶抑制剂及β-受体阻滞剂对瓣膜置换术后患者神经内分泌激素水平的影响[J].中国动脉硬化杂志,2011,19(8):680~683.

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  • 收稿日期:2011-03-09
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