儿童心脏直视术后心肌脂肪酸结合蛋白水平的变化及意义

目的 探讨儿童心脏直视术后外周血心肌脂肪酸结合蛋白(H-FABP)水平的变化及意义.方法 选择先天性心脏病患儿40例,分为晶体停搏液灌注组(Ⅰ组)和含血停搏液灌注组(Ⅱ组),每组20例.测定麻醉诱导前、体外循环结束后不同时间点血浆H-FABP水平.结果 两组麻醉诱导前H-FABP水平比较差异无统计学意义(P>0.05),体外循环结束即刻,1、4、12、24 hH-FABP水平较麻醉诱导前均有不同程度的升高(P<0.01),于体外循环结束后1 h达峰值(P<0.01),Ⅰ组升高比Ⅱ组更明显[(50.13±3.98)μg/L比(39.27±4.22)μg/L,P<0.01].结论 体外循环心脏术后H-FABP显著升高,峰值浓度出现早,可作为一项早期判断心肌损伤的敏感指标.与灌注晶体停搏液相比,含血停搏液有良好的心肌保护作用.

The changes and clinical significance of heart fatty acid-binding protein concentrations in children patients after open heart surgery

Objective To observe the changes and clinical significance of plasma heart fatty acid-binding protein(H-FABP)in children after open heart surgery. Methods Forty patients with congenital heart disease(CHD) who had undergone cardiac operation with cardiopulmonary bypass(CPB) were selected in this study,and were randomly divided into two groups (each 20 cases): cold crystalloid cardioplegia perfusion group (Ⅰ group) and cold blood cardioplegia perfusion group(Ⅱ group). Blood samples were taken to check the plasma H-FABP concentration before CPB and different time after CPB. Plasma H-FABP concentration was estimated by enzyme-linked immunosorbent assay (ELISA). Results The difference of plasma concentration of H-FABP before operation was not obvious between Ⅰ group and Ⅱ group. The plas-ma concentration of H-FABP intraoperation and different time after operation was higher than that before anesthesia induction obviously in two groups, and Ⅰ group rose more significantly [(50.13±3.98) μg/L vs (39.27±4.22) μg/L, P<0.01]. Conclusions H-FABP concentration after operation is higher than that before operation significantly. H-FABP can be used to judge myocardial damage earlier as a sensitive index, because plasma concentration of H-FABP increases significantly after open heart surgery, and its peak emerges early. Compared with cold crystalloid cardioplegia,the myocardial protection of cold blood cardioplegia is better.