中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2008年
12期
1100-1103
,共4页
心肺转流术%心脏缺损,先天性%高血压,肺性%一氧化氮,精氨酸
心肺轉流術%心髒缺損,先天性%高血壓,肺性%一氧化氮,精氨痠
심폐전류술%심장결손,선천성%고혈압,폐성%일양화담,정안산
Cardiopulmonary bypass%Heart defects,congenital%Hypertension,pulmonary%Nitric oxide%Arginine
目的 通过观察体外循环(CPB)对先天性心脏病合并肺动脉高压患者血浆一氧化氮(NO)和不对称二甲基精氨酸(ADMA)浓度的影响,分析CPB加重肺动脉高压的原因.方法 拟在CPB下行心内修补术的先天性心脏病患者18例,年龄11～40岁,体重26～59 kg,ASAⅡ或Ⅲ级,心功能Ⅰ～Ⅲ级.根据术前肺动脉收缩压(PASP)分为3组(n=6),Ⅰ组肺动脉压正常(PASP<30 mm Hg);Ⅱ组肺动脉压轻度增高(PASP 30～50 mm Hg);Ⅲ组肺动脉压中重度增高(PASP>50 mm Hg).分别于麻醉诱导前(基础状态)、CPB开始即刻、CPB停机后即刻、3、6和24 h时采集桡动脉血样4 ml,测定血浆NO和ADMA浓度.结果 与基础值相比,Ⅱ组和Ⅲ组CPB停机后即刻、3和6 h时血浆ADMA浓度升高,NO浓度降低(P<0.05),Ⅰ组上述指标差异无统计学意义(P>0.05).与Ⅰ组比较,Ⅱ组和Ⅲ组血浆NO浓度降低,ADMA浓度升高(P<0.05).结论 CPB可引起先天性心脏病合并肺动脉高压患者血浆ADMA浓度升高,NO浓度降低.
目的 通過觀察體外循環(CPB)對先天性心髒病閤併肺動脈高壓患者血漿一氧化氮(NO)和不對稱二甲基精氨痠(ADMA)濃度的影響,分析CPB加重肺動脈高壓的原因.方法 擬在CPB下行心內脩補術的先天性心髒病患者18例,年齡11～40歲,體重26～59 kg,ASAⅡ或Ⅲ級,心功能Ⅰ～Ⅲ級.根據術前肺動脈收縮壓(PASP)分為3組(n=6),Ⅰ組肺動脈壓正常(PASP<30 mm Hg);Ⅱ組肺動脈壓輕度增高(PASP 30～50 mm Hg);Ⅲ組肺動脈壓中重度增高(PASP>50 mm Hg).分彆于痳醉誘導前(基礎狀態)、CPB開始即刻、CPB停機後即刻、3、6和24 h時採集橈動脈血樣4 ml,測定血漿NO和ADMA濃度.結果 與基礎值相比,Ⅱ組和Ⅲ組CPB停機後即刻、3和6 h時血漿ADMA濃度升高,NO濃度降低(P<0.05),Ⅰ組上述指標差異無統計學意義(P>0.05).與Ⅰ組比較,Ⅱ組和Ⅲ組血漿NO濃度降低,ADMA濃度升高(P<0.05).結論 CPB可引起先天性心髒病閤併肺動脈高壓患者血漿ADMA濃度升高,NO濃度降低.
목적 통과관찰체외순배(CPB)대선천성심장병합병폐동맥고압환자혈장일양화담(NO)화불대칭이갑기정안산(ADMA)농도적영향,분석CPB가중폐동맥고압적원인.방법 의재CPB하행심내수보술적선천성심장병환자18례,년령11～40세,체중26～59 kg,ASAⅡ혹Ⅲ급,심공능Ⅰ～Ⅲ급.근거술전폐동맥수축압(PASP)분위3조(n=6),Ⅰ조폐동맥압정상(PASP<30 mm Hg);Ⅱ조폐동맥압경도증고(PASP 30～50 mm Hg);Ⅲ조폐동맥압중중도증고(PASP>50 mm Hg).분별우마취유도전(기출상태)、CPB개시즉각、CPB정궤후즉각、3、6화24 h시채집뇨동맥혈양4 ml,측정혈장NO화ADMA농도.결과 여기출치상비,Ⅱ조화Ⅲ조CPB정궤후즉각、3화6 h시혈장ADMA농도승고,NO농도강저(P<0.05),Ⅰ조상술지표차이무통계학의의(P>0.05).여Ⅰ조비교,Ⅱ조화Ⅲ조혈장NO농도강저,ADMA농도승고(P<0.05).결론 CPB가인기선천성심장병합병폐동맥고압환자혈장ADMA농도승고,NO농도강저.
Objective To investigate the effects of eardiopulmonary bypass(CPB)on plasma nitric oxide (NO)and asymmetric dimethyl arginine(ADMA)concentrations in patients with congenital heart disease complicated with pulmonary hypertension undergoing open heart surgery.Methods Eighteen ASA Ⅱ or Ⅲ patients aged 11-40 yr weighing 26-59 kg undergoing open heart surgery under CPB were divided into 3 groups according to pulmonary arterial systolic pressure(PASP)(n=6 each):group Ⅰ PASP<30 mm Hg;group Ⅱ PASP 30-50 mm Hg and group Ⅲ PASP>50 mm Hg.Arterial blood samples were taken before induction of anesthesia (To,baseline),at the start and termination of CPB(T1,2)and 3,6,24 h after CPB(T3-5)for determination of plasma NO and ADMA concentrations.Results The three groups were comparable with respect to M/F sex ratio,age,body weight and CPB time.The plasma ADMA concentrations were significantly increased while NO concentrations were significantly decreased at termination of CPB(T2)and 3 and 6 h after CPB(T3,4)as compared with the baseline at T0 in group Ⅱ and Ⅲ.The plasma ADMA concentration were significantly higher and No concentrations were significantly lower at all time points in groupⅡand Ⅲthan in group Ⅰ.Conclusion CPB can increase plasma ADMA concentration and decrease plasma NO concentration in patients with congenital heart disease complicated with pulmonary hypertension undergoing open heart surgery.
