小儿非紫绀型先心病心脏停跳与非停跳体外循环下围手术期的能量代谢研究

目的研究先心病心脏停跳与非停跳体外循环下围手术期的能量代谢变化。方法符合研究标准的患者36例,随机分为实验组(心脏非停跳下)、对照组(心脏停跳组下)各18例,采取围手术期8个时间点(T1~T8)少量血液,依次离心获得血浆,应用NMR代谢组学分析及数据处理获取血浆相关代谢物指标,如ATP浓度、肌酸浓度、乳酸浓度。结果血浆ATP浓度、肌酸浓度、乳酸浓度在围手术期呈现一定时间内规律变化,二组数据比较,T4~T7时间点两组ATP浓度和肌酸浓度差异有统计学意义(P0.05);T4~T8时间点两组乳酸浓度差异有统计学意义(P0.05)。结论两组患者ATP浓度、肌酸浓度、乳酸浓度在体外循环(CPB)过程中的机体组织代谢呈现出一定规律性改变,而实验组与对照组相关数据比较,存在显著差异性,表明在CPB手术过程中,心脏非停跳状态可以较好地保持机体能量代谢平衡状态。

Study of perioperative metabolism in cardiopulmonary bypass for beating heart surgery and non-beating heart surgery in treatment of Non-Cyanotic Congenital Heart Disease Children

Objective To study metabolic changes in Cardio-Pulmonary Bypass（ CPB） for beating heart surgery and non-beating heart surgery in treatment of Non-Cyanotic Congenital Heart Disease.Methods 36 cases were enrolled in the study and were randomly divided into experimental group（ beating heart surgery） and control group（ non-beating heart surgery）. Perioperative blood specimens of 8 different timings（ T1 ~ T8） were collected,followed by centrifuged to obtain blood plasma. NMR was used to detect metabolism-related substances such as ATP concentration,creatine concentration and lactate concentration.Results Plasma ATP,creatinine and lactate concentration were changed regularly during the perioperative time. Ther were significant differences in ATP and creatinine concentration at the timings of T4 ~ T7,so were lactate concentration at the timings of T4 ~ T8. Conclusion The plasma concentrations of ATP,creatinine and lactate vary periodically during CPB process. The balance of energy metabolism may be maintained during CPB for beating heart surgery.