CAJ | 학술논문

目的观察心内直视手术患儿体外循环(cardiopulmonary bypass,CPB)术后心肌损伤情况,并评价灯盏花素是否具有心功能保护作用.方法择期行室间隔缺损修补术的学龄前患儿(≤6岁)36例,随机分成对照组(生理盐水)、低剂量灯盏花素组(低剂量组,0.5 mg/kg灯盏花素)和高剂量灯盏花素组(高剂量组,1 mg/kg灯盏花素)3组,每组各12例.于麻醉诱导完成后开始微泵静脉输注15 Ml生理盐水或灯盏花注射液,30 min内输注完毕.分别于术前(T_0)、主动脉阻断开放即刻(T_1)、开放30 min(T_2)、1 h(T_3)、术后6h(T_4)及术后24 h(T_5)测定血浆肌钙蛋白-I(cTn-I)及丙二醛(MDA)浓度.同时记录手术时间、CPB时间、主动脉阻断时间以及术后24 h引流情况.记录所有患儿术中使用的咪达唑仑、异丙酚和芬太尼总量.结果 3组患儿主动脉阻断时间、CPB时间、手术时间和术中咪迭唑仑、异丙酚和芬太尼总量以及术后引流量比较差异均无统计学意义.与基础值(T0点)比较,3组患儿cTn-I于主动脉阻断开放后即刻、6 h及24 h(T_1、T_4、T_5点)明显升高(P＜0.01),峰值出现于主动脉阻断开放后6 h(T_4点).与对照组比较,低剂量组cTn-I值在T_1、T_4时间点较低(P＜0.01),高剂量组在T_1、L_4、T_5时间点较低(P＜0.01),两剂量组间差异无统计学意义.3组患儿血浆MDA浓度在T1时点开始升高,并在主动脉开放后30 min(T2点)出现峰值,之后开始下降,并在T5时间点降至术前水平;与对照组比较,低、高剂量组于T_1、T_2、T_3、T_4时点浓度较低(P＜0.01).结论心内直视手术患儿体外循环后均发生不同程度的心肌功能损害,在主动脉阻断开放后24 h内cTn-I的高峰值出现于主动脉阻断开放后6 h.灯盏花素治疗组血浆cTn-I及MDA浓度较低,表明体外循环前静脉输注灯盏花素对体外循环心内直视手术所致心肌损伤具有一定的保护作用.
목적 관찰심내직시수술환인체외순배(cardiopulmonary bypass,CPB)술후심기손상정황,병평개등잔화소시부구유심공능보호작용.방법 택기행실간격결손수보술적학령전환인(≤6세)36례,수궤분성대조조(생리염수)、저제량등잔화소조(저제량조,0.5 mg/kg등잔화소)화고제량등잔화소조(고제량조,1 mg/kg등잔화소)3조,매조각12례.우마취유도완성후개시미빙정맥수주15 Ml생리염수혹등잔화주사액,30 min내수주완필.분별우술전(T_0)、주동맥조단개방즉각(T_1)、개방30 min(T_2)、1 h(T_3)、술후6h(T_4)급술후24 h(T_5)측정혈장기개단백-I(cTn-I)급병이철(MDA)농도.동시기록수술시간、CPB시간、주동맥조단시간이급술후24 h인류정황.기록소유환인술중사용적미체서륜、이병분화분태니총량.결과 3조환인주동맥조단시간、CPB시간、수술시간화술중미질서륜、이병분화분태니총량이급술후인류량비교차이균무통계학의의.여기출치(T0점)비교,3조환인cTn-I우주동맥조단개방후즉각、6 h급24 h(T_1、T_4、T_5점)명현승고(P＜0.01),봉치출현우주동맥조단개방후6 h(T_4점).여대조조비교,저제량조cTn-I치재T_1、T_4시간점교저(P＜0.01),고제량조재T_1、L_4、T_5시간점교저(P＜0.01),량제량조간차이무통계학의의.3조환인혈장MDA농도재T1시점개시승고,병재주동맥개방후30 min(T2점)출현봉치,지후개시하강,병재T5시간점강지술전수평;여대조조비교,저、고제량조우T_1、T_2、T_3、T_4시점농도교저(P＜0.01).결론 심내직시수술환인체외순배후균발생불동정도적심기공능손해,재주동맥조단개방후24 h내cTn-I적고봉치출현우주동맥조단개방후6 h.등잔화소치료조혈장cTn-I급MDA농도교저,표명체외순배전정맥수주등잔화소대체외순배심내직시수술소치심기손상구유일정적보호작용.
Objective To assess the condition of myocardial injury after cardiopulmonary bypass (CPB)and the effects of breviscapine (BVC) on cardiac function in children undergoing open heart surgery.Methods Thirty-six children (ASA Ⅱ or Ⅲ,aged 2-65 months) scheduled to receive ventricular septal defect repairing were randomly assigned to three groups,the control group treated with saline,and the BVC treated groups treated respectively with low dose (0.5 mg/kg) and high dose(1.0 mg/kg) BVC,12 patients in each group.Saline or BVC(in volume of 15 Ml) was administered intravenously after induction of anesthesia with micro-pump within 30 min.Blood levels of troponin I (cTn-I)and malondialdehyde (MDA) were measured at different time points:pre-operation (T_0),during aortic unclamping (T_1),and 30 min,1 h,6 h,24 h after aortic unclamping (T_2,T_3,T_4,T_5).And the time of operation,CPB,aortic unclamping,and the condition of drainage in 24 h after operation as well as the dosages of narcotics (midazolam,propofol and fentanyl) used were recorded.Results No significant difference among groups was found in terms of sex ratio,age,body weight,time of aortic unclamping,CPB and operation,as well as the dosages of narcotics used and the volume of post-operation drainage.Compared with baseline(T_0),levels of cTn-I at T_1,T_4 and T_5 increased significantly in all three groups(P＜0.01),with the peak revealed at T_4;cTn-I in the control group were higher than those in the low dose BVC treated group at T,and T_4(P＜0.01),and those in the high dose BVC group at T_1,T_4,and T_5,while it was insignificantly different between the two BVC treated groups.Level of plasmal MDA began to rise in all groups at T_1 with the peak revealed at T_2,it lowered after then,and reached the baseline at T_5;comparison between groups showed that it was lower in the BVC treated groups than in the control group at T_1- T_4.Conclusions Different degree of cardiac injury always happens after open heart surgery and CPB,showing high level of cTn-I within 24 h with the peak revealed at 6 h after aortic unclamping.Intravenous perfusion BVC before CPB at the dose of 0.5 or 1 mg/kg could protect the cardiac function to some extent.