去白细胞温血心脏停搏液对幼儿未成熟心肌的保护作用  

Protective Effect of Leukocyte-Depleted Warm Blood Cardioplegia on Immature Myocardium of Infant

作　　者：权晓强[1] 法宪恩[2] 程兆云[1] 

机构地区：[1]河南省人民医院心血管外科 [2]郑州大学第二临床医学院心血管外科,郑州450003

出　　处：《实用儿科临床杂志》2008年第11期827-828,共2页Journal of Applied Clinical Pediatrics

基　　金：河南省自然科学基金项目资助(0311040300)

摘　　要：目的评价去白细胞温血心脏停搏液对幼儿未成熟心肌的保护作用。方法临床随机选取美国麻醉医师协会(ASA)Ⅱ、Ⅲ级,主动脉阻断时间在30min和体外循环时间在40min以上的先天性心脏病患儿30例,分为去白细胞温血心脏停搏液组(试验组)和普通温血心脏停搏液组(对照组)各15例。在检测术中患儿血流动力学的前提下,二组分别于体主动脉阻断前(T1)、主动脉阻断30min(T2)、主动脉开放5min(T3)、15min(T4)分别采集肝素抗凝桡动脉血检测其血浆心肌肌钙蛋白I(cTnI)及细胞间黏附分子-1(ICAM-1);同时测定右心房心肌髓过氧化物酶(MPO)水平。结果1.主动脉开放后各时间点先天性心脏病患儿cTnI、ICAM-1均较术前升高,且对照组高于试验组(t=2.358,2.533,2.30,2.639Pa<0.05)。2.心肌MPO水平主动脉开放后对照组明显升高,试验组无明显变化,对照组高于试验组(t=2.546,2.915Pa<0.01)。结论血清cTnI可反映早期心肌损伤程度,对判断体外循环心脏术后心肌保护效果有重要参考价值。去白细胞温血心脏停搏液对未成熟心肌有较好的心肌保护作用。Objective To evaluate the protective effect of leukocyte - depleted warm blood cardioplegia on immature myocardium in infant. Methods Thirty infants with congenital heart disease whose American Society of Anesthesiologists （ASA） were Ⅱ - Ⅲ,aortic damping time and bypass time were more than 30,40 minutes were respectively selected and divided into 2 groups：Experimental group and control group. Experimental group were perfused with leukocyte - depleted warm blood cardioplegia while control group perfused with common warm blood cardiplegia. Under monitoring the hemodynamics at surgery, the serum levels of troponin Ⅰ （cTnI） and intercellular adhesion molecule - 1 （ ICAM - 1 ） in heparinized anticoagulant blood samples from radial artery at different time points [ anesthesia induction and before extracorporeal circulation（ T1 ） ,30 min after aortic clamping（ T2 ） and aortic declamping 5 min（ T3 ）, 15 min（ T4 ） ] were detected. Three pieces of cardiac muscle were taken from right atrium at different time points and the levels of myeloperoxidase （MPO） were detected. Results 1. The serum cTnI and ICAM - 1 levels after aortic declamping were higher than those before operation, and the levels in experimental group were lower than those in control group（t =2.358,2. 533,2.30,2. 639 P 〈0.05）. 2. After aortic declamping,there was no significant difference in MPO content in experimental group but great increase in control groop （t = 2： 546,2. 915 Pa 〈 0.05 ）. Conclusions cTnI level can reflect early injury and supply important reference value of judging myocardial protective effect after extracorporeal circulation. Leukocyte - depleted warm blood cardioplegia can protect the immature cardiac muscle better than common warm blood cardioplegia.

关 键 词：心脏停搏液 去白细胞 心肌保护 心肌肌钙蛋白Ⅰ 细胞间黏附分子-1 未成熟心肌 

分 类 号：R726.5[医药卫生—儿科]