艾司洛尔对紫绀型先天性心脏病患儿CPB过程中心肌损伤及能量代谢的影响

目的 探讨艾司洛尔对紫绀型先天性心脏病（CCHD）患儿体外循环（CPB）过程中心肌损伤的影响及机制.方法 将16例行CPB下心内直视术CCHD患儿随机分为观察组和对照组各8例,两组手术方法及麻醉方法均相同,但自麻醉诱导至术毕观察组和对照组分别静脉泵注艾司洛尔3 mg/（kg·h）及等量复方氯化钠溶液.观察两组手术一般情况,并分别于转流前（T1）、主动脉阻断后30 min（T2）、主动脉开放后30 min（T3）、术后24 h（T4）采集中心静脉血,测定肌酸激酶同工酶（CK-MB）、肌钙蛋白I（cTnI）水平,并于T1、T3取右心耳组织测定心肌组织腺甘酸含量及线粒体肿胀度（MSD）.结果 观察组复跳后心律失常发生率、多巴胺用量、ICU滞留时间及术后住院时间均显著小于对照组（P均〈0.05）;与T1时比较,两组T3和T4时血清CK-MB和cTnI水平明显升高、T3时心肌腺苷酸含量显著减少,MSD显著升高（P均〈0.01）,但观察组变化幅度均显著小于对照组（P〈0.05）.结论 艾司洛尔可通过改善心肌能量代谢及线粒体功能等途径减轻CCHD患儿CPB过程中缺血再灌注损伤.

Effects of esmolol on myocardial injury and energy metabolism during cardiopulmonary bypass in children with cyanotic congenital heart disease

Objective To investigate the effects and mechanisms of esmolol on myocardial injury during cardiopulmonary bypass（CPB） in children with cyanotic congenital heart disease （CCHD）. Methods Sixteen patients with CCHD performed intracardiac operation under direct vision with CPB were divided randomly into observed group and control group with 8 cases in each, same operation and anesthesia method were used in the two groups,the observed group was given an esmolol infusion at a dose of 3 mg/（ kg · h） from the induction to the end of operation,while the control group was given finger＇s solution instead. The general conditions of operation in both groups were observed, and blood sample was taken from central vein to detect the plasma concentration of MB isoenzyme of creatine kinase （CK-MB） , cardiac tropinon I （cTnI） before CPB （ T1 ） , 30 min after aorta clamped （ T2 ） , 30 min after aorta unclamped （ T3 ） and 24 h after the surgery （ T4 ）. The contents of adenylic acid and mitochondrial swelling degree （MSD） in auricula dextra tissue were detected at T1, T3. Results The incidence of arrythymia, the dosage of dopamine, the time stay in ICU and days of hospital stay after surgery were markedly fewer in observed group than that in control group （ P 〈 0.05） ; the leves of CK-MB and cTnI at T3 and T4 were significantly higher than those at T1 in both groups, the contents of adenylic acidat T3 were significantly lower than that at T1 and MSD at T3 significantly higher than that at T1 （all P 〈0.01 ） ,but the leves of CK-MB and cTnI in observed group were lower at T3 and T4 than those in control group （P 〈 0.05）. Conclusion During the CPB of children with CCHD, esmolol can substantially attenuate myocardial ischemia/reperfusion injury by ameliorating myocardial energy metabolism and mitochondrial function.