儿童心肺转流对营养代谢的影响

目的本研究旨在了解婴幼儿心肺转流（CPB）中营养物质的变化。方法选取40例15 kg以下先天性心脏病患儿,分别在手术开始、主动脉阻断时、主动脉开放、CPB结束、改良超滤（MUF）后、术后2 h和20 h测定血糖,游离脂肪酸,血清总蛋白。结果血糖浓度在CPB开始时有明显上升（P〈0.01）,CPB过程中无明显变化,术后先上升后下降。游离脂肪酸在CPB开始时明显下降（P〈0.01）,经MUF后迅速上升（P〈0.01）,此后逐渐下降,术后20 h明显低于基础值（P〈0.01）。CPB中蛋白水平明显下降（P〈0.01）,术后虽逐渐上升,但到术后20 h,其水平仍低于术前（P〈0.05）。结论在儿童CPB中营养代谢的变化和成人有明显不同,CPB过程中血糖和脂肪酸的上升幅度不明显,且术后血糖,脂肪酸和蛋白质都处于较低水平,因此对小婴儿心脏手术围术期的营养支持应加以特别的关注。

Effect of Cardiopulmonary Bypass on Nutrition in Children

OBJECTIVE To evaluate the effect of cardiopulmonary bypass（CPB） on nutrition in children.METHODSForty children,less than 15 kg,with congenital heart defects were chosen in the study.The blood samples were collected at pre-operation,aortic clamp on,aortic clamp off,CPB wean off,MUF cessation,post-operative 2 hours and post-operative 20 hours for measurement of the concentration of glucose,protein and fatty acid.RESULTS The concentration of glucose increased significantly at the beginning of CPB（P〈0.01）,and didn＇t change during bypass.Post-operatively,it increased first and decreased 20 hours later.The concentration of free fatty acid decreased when CPB began（P〈0.01）,and increased during MUF（P〈0.01）.Post-operatively,it decreased progressively and was significantly lower than baseline（P〈0.01） at postoperative 20 hours.The concentration of total protein decreased during CPB（P〈0.01） and increased progressively after CPB.However,it was still lower than baseline（P〈0.05） at postoperative 20 hours.CONCLUSION The metabolism of nutrition substances is unique in children.Unlike adults,the concentrations of blood glucose and free fatty acid didn＇t raise significantly during CPB,and the glucose,fatty acid and protein are in low level postoperatively.The nutrition support plays an important roles in pediatric cardiac surgery and more attention should be paid to this area.