| Objective: With the improvement of living standards, the morbidity andthe mortality caused by coronary heart disease in China are also increasingyear by year. The patients and the younger trend with coronary heart disease(CHD) that need to accept non-cardiac surgery are becoming more and more.Although coronary heart disease is not surgical contraindications to itself, as aresult of the large differences of the degrees for the patients to tolerate theanesthesia and the surgery, some cardiac adverse events frequently occur.Many factors such as non cardiac operation in hemodynamic fluctuationsandfluid intake and output can aggravate myocardial ischemia in patientswith high risk factors, become the perioperative blood dirty events Researchhas shown that about30%perioperative complications and50%postoperativedeaths of the culprit are perioperative cardiovascular events (perioperativecardiovascular events, PCE), but for the patients diagnosed with coronaryheart disease, the incidence of PCE will be higher at the time of the surgeryand the risk of the operation is bigger. So according to the preoperative riskstratification of the patients with coronary heart disease, it is an importantmeasure to filter non-cardiac surgery patients who can tolerate suchprocedures to avoid Perioperative cardiovascular events，Related researchreports and it is not sufficient. High-sensitivity c-reactive protein (hs-CRP)and troponin (cTn) in the patients with coronary heart disease are thetraditional clinical predictor of PCE, but there are still some shortcomings andlimitations.At present, the domestic and foreign research results show thatBNP is expected to become the assessment of patients undergoing noncardiac operation is a good method of cardiac events, and the BNP’s effect isbetter than that of the troponin (cTn) and the high-sensitivity c-reactive protein(hs-CRP), etc. this clinical trial is to study the relationship between the preoperative plasma BNP concentration and the perioperative cardiovascularevents during the non-cardiac surgery for the patients with coronary heartdisease,and the significance of changes in the BNP levels of the patients withevery type of coronary heart disease who accept the non-cardiac surgery.Methods: To select128cases among the patients with coronary heartdisease, aged34-82, in the elective line of the non-cardiac surgery in theFourth Hospital of Hebei Medical University in August2012to December2013. The average age was56.3±11.9, with78cases of male patients, and50cases of female patients.78cases of abdominal surgery and50cases ofsuperficial tissue surgery,21cases of head and neck surgery,9cases of chestsurgery. They were all reviewed as Guidelines for Diagnosis and Treatmentof Chronic Stable Angina Pectoris, Guidelines for Diagnosis and Treatmentof Unstable Angina and Non ST Elevation Myocardial Infarction andGuidelines for Diagnosis and Treatment of Acute Myocardial Infarction,among which there are42patients with myocardial infarction (MI),65patients with unstable angina (UA), and21patients with stable angina (SA).Before surgery,each patient is conventionally taking B receptor blockers,ACEI, statin drugs, and stop taking aspirin.All of the patients were dividedinto two groups, Groups A and B, according to the results of the measurements.The blood samples of all the patients were separately collected24hoursbefore and2hours after the operation to measure the plasma BNP levels. Thepreoperative BNP concentrations of the patients in Group A are less than orequal to100pg/mL. The preoperative BNP concentrations of the patients inGroup B are100-400pg/mL. Using the application SPSS17.0statisticalsoftware to compare the changes of the BNP levels in the three groups,and theperioperative cardiac events happening in the patients in Groups A and B. AndP <0.05is considered to have statistical significance.Results:13cases of cardiovascular events of the patients with coronary heartdisease (CHD) in Group A are unstable angina.15cases of the cardiovascularevents in patients with coronary heart disease (CHD) in Group B, of which there are6cases of unstable angina,1case of myocardial infarction,3cases ofsevere arrhythmia, and5cases of acute left heart function failure. By thestatistical analysis software, preoperative plasma BNP levels are100-400pg/mL in the patients with coronary heart disease risk of perioperativecardiovascular events than the plasma BNP levels in the patients are less thanor equal to100pg/mL.2The cases of cardiovascular events of the patients with coronary heartdisease (CHD) in Group MI,UA and SA were10cases,7cases and1case.areunstable angina (495±238) pg/mL. And the incidence of cardiovascularevents were23.8%,10.8%and4.8%.The BNP levels before and after thesurgery in Group MI were （367.3±74.4）pg/mL and（407.8±96.3）pg/mL,inGroup UA were （178.7±62.1）pg/mL and（182.1±59.7）pg/mL,and in GroupSA wer（e45.2±23.7）pg/mL and（44.0±21.2）pg/mL. By the statistical analysis,the change of the BNP level in Group MI has statistical significance,P <0.05,but the change dose not happen in Group UA and Group SA. That means,the higher the degree of the patients with coronary heart disease is, the biggerthe change of the BNP level is, and the greater the risk of perioperativecardiovascular events during the non cardiac surgery is.Conclusion:1The preoperative plasma BNP level can be used as a predictive factoeof non cardiac surgery in patients with coronary heart disease in perioperativecardiovascular events,that is the higher the preoperative BNP level is, thegreater the risk of perioperative cardiovascular events during the non cardiacsurgery is.2Has a greater impact on cardiac function in patients with coronary heartdisease in non cardiac operation on BNP concentration significantlyabnormal,cardiovascular events caused by the possibility of a larger... |
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