德国学者Berendes E博士及其同事对进行心脏
手术的病人中A-型（ANP）和B-型（BNP）钠尿肽的分泌机制和预后进行了评价。研究者分别检测接受冠脉搭桥（CABG）和换瓣病人的ANP和BNP值。将CABG再分为心室功能不全组（28例）和无心室功能不全组（32例）；换瓣组分为二尖瓣组（21例）和主动脉瓣组（24例）。术后死亡率随访到术后730天。
研究结果表明，ANP的浓度与主动脉夹闭后心脏的再灌注容量密切相关。手术中BNP的分泌机制很不一致。BNP的浓度在体外循环的病人中与主动脉夹闭的时间（r2=0.32；P=0.006）和术后肌钙蛋白I的浓度（r2=0.22；P=0.0009）相关，在这些病人中术前BNP的浓度增高和术后（两年）的死亡率有关。在二尖瓣替换（增高3倍）和主动脉瓣替换（增高14倍）的患者中术前显著增高的BNP在术后不再继续增高。
Berendes博士等认为，这些数据表明ANP主要与主动脉夹闭后心脏的再灌注容量相关，而BNP和其他因素，如长期左室内压和/或血管内容量超负荷有关。因此，BNP而非ANP，在CABG病人中可以作为一种预测死亡率的因素。
Anesth Analg. 2004 Jan;98(1):11-9, table of contents.
A-type and B-type natriuretic peptides in cardiac surgical procedures.
Berendes E, Schmidt C, Van Aken H, Hartlage MG, Rothenburger M, Wirtz S, Scheld HH, Brodner G, Walter M.
Klinik und Poliklinik fur Anasthesiologie und Operative Intensivmedizin, University of Munster, Albert-Schweitzer-Strasse 33, 48149 Munster, Germany.
This study was performed to determine the secretion pattern and prognostic value of A-type (ANP) and B-type (BNP) natriuretic peptide in patients undergoing cardiac surgical procedures. We measured ANP and BNP in patients undergoing coronary artery bypass grafting (CABG) with (n = 28) or without (n = 32) ventricular dysfunction and in patients undergoing mitral (n = 21) or aortic (n = 24) valve replacement, respectively. Postoperative mortality was recorded up to 730 days after operation. ANP, but not BNP, concentrations were closely associated with volume reloading of the heart after aortic cross-clamp in all patients. The secretion pattern of BNP during surgery was much less uniform. BNP, but not ANP, concentrations correlated with aortic cross-clamp time (r(2) = 0.32; P = 0.006) and postoperative troponin I concentrations (r(2) = 0.22; P = 0.0009) in bypass patients, and preoperative BNP increases were associated with a more frequent postoperative (2-yr) mortality in these patients. Markedly increased preoperative BNP concentrations in mitral (3-fold) and aortic (14-fold) valve disease patients did not further increase during cardiopulmonary surgery. The data suggest that ANP is primarily influenced by intravascular volume reloading of the heart after cross-clamp, whereas the secretion of BNP is related to other factors, such as duration of ischemia and long-term left ventricular pressure and/or excessive intravascular volume. BNP, but not ANP, was shown to be a mortality risk predictor in patients undergoing CABG. IMPLICATIONS: A-type natriuretic peptide is primarily influenced by volume reloading of the heart after cross-clamp, whereas the secretion of B-type natriuretic peptide (BNP) is related to the duration of ischemia and long-term left ventricular pressure and/or volume overload. Preoperative BNP, but not postoperative BNP, concentrations predict long-term outcome after coronary artery bypass grafting.
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