灯盏花素对体外循环心内直视手术患儿心肌损伤的保护作用

作者	单位
谢文锡	温州医学院附属第二医院麻醉科,胸外科
岳利民	温州医学院附属第二医院麻醉科,胸外科
宋海龙	温州医学院附属第二医院麻醉科,胸外科
连庆泉	温州医学院附属第二医院麻醉科,胸外科
陈小玲	温州医学院附属第二医院麻醉科,胸外科
蒋懿斐	温州医学院附属第二医院麻醉科,胸外科
费建斌	温州医学院附属第二医院麻醉科,胸外科
金胜威	温州医学院附属第二医院麻醉科,胸外科
李军	温州医学院附属第二医院麻醉科,胸外科
上官王宁	温州医学院附属第二医院麻醉科,胸外科

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中文摘要:

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(T0)、主动脉阻断开放即刻(T1)、开放30 min(T2)、1 h(T3)、术后6h(T4)及术后24 h(T5)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、手术时间和术中咪达唑仑、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(T1、T4、T5点)明显升高(P<0.01),峰值出现于主动脉阻断开放后6 h(T4点)。与对照组比较,低剂量组cTn-I值在T1、T4时间点较低(P<0.01),高剂量组在T1、T4、T5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T1、T2、T3、T4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。

英文摘要:

ObjectiveTo 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.MethodsThirty-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(T0),during aortic unclamping(T1),and 30 min,1 h,6 h,24 h after aortic unclamping(T2,T3,T4,T5).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.ResultsNo 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(T0),levels of cTn-Ⅰ at T1,T4 and T5 increased significantly in all three groups(P<0.01),with the peak revealed at T4;cTn-Ⅰ in the control group were higher than those in the low dose BVC treated group at T1 and T4(P<0.01),and those in the high dose BVC group at T1,T4,and T5,while it was insignificantly different between the two BVC treated groups.Level of plasmal MDA began to rise in all groups at T1 with the peak revealed at T2,it lowered after then,and reached the baseline at T5;comparison between groups showed that it was lower in the BVC treated groups than in the control group at T1-T4.ConclusionsDifferent 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.

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