儿童体外循环内源性类洋地黄物质变化  

Changes of Endogenous Digoxin-like Substance During Cardiopulmonary Bypass in Children

作　　者：皮名安[1] 杨楚墩[1] 江泽熙[1] 段栩飞[1] 

机构地区：[1]武汉市儿童医院心外科,湖北武汉430016

出　　处：《临床小儿外科杂志》2002年第6期431-434,共4页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨内源性类洋地黄物质与儿童心功能之间的关系及其在体外循环期间变化的临床意义。方法80例先天性心脏病患儿根据心功能分级分为4组,按先天性心脏病分类分为2组,于术前,主动脉阻断后,转流30min,心脏复苏后和术后24h测定血浆EDLS浓度。结果⑴儿童血浆EDLS浓度在心功能代偿期与正常对照组无显著性差异,而心功能不全各级分别显著高于正常组,并随心功能不全程度加重而增加;⑵体外循环期间以循环阻断后EDLS浓度最低,随着心脏复苏EDLS浓度逐渐升高,至术后24hEDLS浓度恢复至术前水平;⑶青紫型先天性心脏病与非青紫型先天性心脏病比EDLS血清浓度有显著性差异,而转流期间变化不大。结论⑴EDLS血浆浓度与心功能不全的严重程度呈密切相关,成为维持心脏功能代偿的因素之一;⑵EDLS随容量负荷增加而增加;⑶儿童心脏病术后适当应用洋地黄制剂是安全的。Objective To investigate the relationship between endogenous digoxin -like substance(EDLS)and cardiac function before and during cardiopulmonary bypass(CPB)in children with congenital heart disease(CHD).Methods According to the preoperative cardiac function,80patients with congenital heart disease(acyanotic63,cyanotic17)before operation were divided into4groups,namely degree I(n=24)degree II(n=20),degree III(n=20)and degree VI (n=16).Their age ranged from1month to8years.Twenty-five normal children(age5～8years)served as normal controls.The concentration of plasma EDLS was measured by radioimmunoassay at pre -bypass,30mins after aortic clamping,heart starting ejection and24hours after operation respectively.Results The level of EDLS in cardiac compensatory stage had no difference with the normal control,but in the cardiac insufficiency group was higher than that of the controls(P<0.01).The EDLS level was elevated with cardiac insufficiency progression.The EDLS was decreased at aortic clamping,and increased gradually after cardiac resuscitation,returned to the preoperative level at24hours after operation.The level of serum EDLS in the acyanostic CHD groups was higher than that of cyanotstic cases.Conclusions The concentration of plasma EDLS is a close correlation with the degree of cardiac insufficiency.EDLS may be one of the factors to maintain the cardiaccompensation mechanism and is influenced by increasing volume load.Application of suit abledo sage of digitalis prepar ationis safety for somecases after CHDrepair.

关 键 词：洋地黄 代谢 体外循环 

分 类 号：R726.541[医药卫生—儿科]