幼儿浅低温不停跳心内直视手术围术期内皮素和肿瘤坏死因子的动态变化观察

目的观察婴幼儿浅低温不停跳与停跳心内直视手术围术期血液中内皮素(ET)和肿瘤坏死因子(TNF)的动态变化。方法对22例浅低温不停跳与停跳心内直视手术幼儿用放射免疫法测定围术期即体外循环转流前、转中、转后、术后6、12、24h血浆中ET和TNF的浓度变化。结果两组比较,体外循环时间、气管插管机械辅助通气时间、转中尿不停跳组患者明显少于停跳组,差异有统计学意义(P<0.05);两组患儿体外循环后ET明显升高,术后6h达高峰,ET浓度明显高于转前水平,差异有统计学意义(P<0.05)。停跳组、不停跳组TNF水平转中、转后及术后不同时间与转前相比差异均无统计学意义(P<0.05)。结论不停跳心内直视手术能缩短手术时间,减轻炎性反应,是一种有效的心肌保护方法。

Effect of Perioperative Beating Heart on Endothelin and Tumor Necrosis Factor in Pediatric Open-Heart Surgery

Objective To investigate effects of perioperative beating heart on endothelin(ET) and tumor necrosis factor(TNF) in pediatric open-heart surgery.[WT5H1]Methods The plasma ET and TNF concentrations were measured by radioimmunoassay in 22 pediatric patients who underwent open-heart operations.Blood samples were taken at pre-CPB,intro-CPB,post-CPB,6,12,24 hours after operations.Results The CPB time of beating heart group were significantly shorter than that of control group(38 min vs 58.09 min,P<0.05).The duration of intubation of beating heart group were significantly shorter than that of control group(5.17h vs 9.23h,(P<0.05).) In both groups,the concentrations of ET increased during CPB compared with that of the pre-CPB period,which reached the highest point at 6 hours after operation,and yet didn't return to that of the pre-CPB time.Conclusion Open-heart surgery with beating heart and mild hypothermic cardiopulmonary bypass(CPB) could ameliorate myocardial injury and ease the inflammatory reaction.