儿童体外循环围术期内源性一氧化氮浓度的变化  

Changes of Endogenous Nitric Oxide During Cardiopulmonary Bypass in Children

作　　者：皮名安[1] 杨楚墩[1] 江泽熙[1] 

机构地区：[1]武汉市儿童医院胸心外科,湖北武汉430016

出　　处：《临床小儿外科杂志》2003年第6期435-437,共3页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨儿童体外循环期间内源性一氧化氮(NO)浓度的变化及意义。方法将先心病患儿分为非紫绀型与紫绀型组非紫绀型再分为肺高压与非肺高压组于转流前、主动脉阻断后、转流结束、术后24h、术后72h和术后7d测定NO浓度。结果主动脉阻断后略有降低体外循环结束时显著增高术后第1d仍处于较高水平术后第3d恢复正常;在体外循环期间紫绀型与非紫绀型先心病血浆NO浓度的比较有显著意义;非肺高压组NO浓度升高显著肺高压组则升高较少两组术后24h及72h的比较有显著意义。结论本实验显示术后24h、术后72hNO浓度升高显著可能与体外循环所致的炎性反应有关肺高压组则升高较少易发生肺高压危象这也是术后NO治疗肺高压危象的基础。Objective To investigate changes and significance of endogenous nitric oxide (NO) during cardiopulmonary bypass (CPB) in children. Methods Seventy patients with congenital heart disease (CHD) in which 55 cases were diagnosed as ventricular septal defect or atrial septal defect (acyanotic type) and 15 were diagnosed as Tetralogy of Fallot or transposition of great arteries (cyanotic type). According to the preoperative pulmonary arterial pressure (PAP), acyanotic patients were divided into pulmonary hypertension (PH) group (n=20) and normal pulmonary pressure group ( n=35) .Their age ranged from 6 month to 8 years (mean, 3.5years). The concentration of NO in plasma was measured before bypass, after aortic cross clamping, weaning from CPB, 24hr, 72hr and 7 days after operation respectively. Results The level of NO was decreased slightly after aortic cross clamping and increased significantly after discontinuation of CPB, and returned to the preoperative level ,72 hours postoperatively. The level of serum NO in the acyanotic (CHD) group was higher than that of cyanotic group. The level of serum NO in cases of CHD without PH was increased obviously than that of CHD with PH group. Conclusions It is suggested that the inflammatory reaction and reperfusion damage may lead to the plasma NO increasing within 3 days after CPB. As compared with patients of CHD without PH, the levels of serum NO in those complicated with PH cases is less increased, it might be one of the factors inducing the postoperative pulmonary artery hypertensive crisis.

关 键 词：体外循环 一氧化氮 手术期问 

分 类 号：R726.541[医药卫生—儿科]