HUMAN ATRIAL NATRIURETIC PEPTIDE INFUSION IN THE MANAGEMENT AFTER OPEN HEART OPERATIONS

Abstract

Cardiopulmonary bypass (CPB) induces water retention in the third space. Furosemide often makes hemodynamic. condition unstable in the immediate postoperative period, and its diuretic effect is poor in the severely-activated renin-angitotensin-aldosterone system (RAAS). Human atrial natriuretic peptide (hANP) has a strong diuretic effect and suppresses the RAAS activation. We evaluate the efficacy of hANP infusion in the postoperative management, and 30 patients (M:F =18:12, 65.2±9.5 years) were allocated to 2 groups: Group H received 0.025 ug/kg/min of hANP (HANP: Zeria Pharmaceutical) from the end of CPB (n = 14) and Group C was served as control (n = 16). In Group H, hemodynamic parameters (CVP, PAP, PCWP) were significantly lower and the cardiac index was significantly higher. There was no significant difference in the postoperative dopamine dosage between the groups. The plasma volume required during the initial 24 hours was smaller in Group H (153.8± 149.3 vs 388.2 ± 291.8 mL, p < 0.05). The total dosage of furosemide during the first 72 hours was smaller in Group H (24.6±18.5 vs 89.4±33.3 mg, p < 0.01). On the 1st postoperative day, the renin activity (6.7±2.5 vs 18.±6.4 ng/mL/hr, p < 0.01) and plasma aldosterone (79.7±27.7 vs 158.4±50.3 pg/mL, p < 0.01) were lower in Group H. These results suggest that the postoperative hANP infusion provides a sufficient diuretic effect without affecting hemodynamic condition.