体外循环中梯度控制氧分压对紫绀型先天性心脏病心肌保护的影响  

Effects of Arterial Oxygen Partial Pressure during Cardiopulmonary Bypass on Myocardial Enzymes and cTnI of Cyanotic Congenital Heart Disease

作　　者：陈萍[1] 黄劲松[1] 郭阳娇[1] 宋兴荣[1] 黄克力[1] 

机构地区：[1]广东省人民医院东省心血管病研究所心外科,广东广州510080

出　　处：《中国体外循环杂志》2009年第2期69-71,共3页Chinese Journal of Extracorporeal Circulation

基　　金：广东省自然科学基金(项目编号5300739)

摘　　要：目的探讨体外循环(CPB)中梯度控制动脉氧分压(PaO2)对紫绀型先天性心脏病心肌保护的影响。方法3岁以下经皮血氧饱和度<85%、行根治术的法洛四联症患儿90例,随机分为三组:实验1组(G1组,n=30)以接近患儿术前水平的低氧分压启动CPB并控制CPB中血流复温前的PaO2≤130mmHg,CPB血流复温后使PaO2逐渐升至250～300mmHg;实验2组(G2组,n=30)CPB中PaO2在250～300mmHg启动CPB,血流复温后使PaO2逐渐升至450～500mmHg;对照组(G3组,n=30)CPB中PO2始终控制在450～500mmHg。观察心肌生化改变:于CPB前、CPB10min、升主动脉开放(CCR)10min、术后6h、24h抽外周血检测心肌酶CKMB、LDH活性及cTnI浓度。结果①CKMB:CPB前及CPB10min三组间无差异;CCR10min、术后6h及24hG1组显著低于G3组(P<0.01);CCR10minG2组显著低于G3组(P<0.05)。②LDH:CPB前及CPB10min三组间无差异;CCR10min、术后6h和24hG1组显著低于G3组(P<0.01或P<0.05)。③cTnI:CPB前及CPB10min三组间无差异;CCR10min、术后6h、术后24hG1组显著低于G3组(P<0.01);术后6hG2组cTnI也显著低于G3组(P<0.05)。结论对于紫绀型先天性心脏病,CPB中PaO2控制在G1组的低水平能减少CKMB、LDH活性及cTnI的释放,改善心肌保护效果。OBJECTIVE To evaluate the effects of arterial oxygen partial pressure （ PaO2 ） at the beginning and during cardiopulmonary bypass （CPB） on myocardial injury of cyanotic congenital heart diseas. METHODS 90 Children diagnosed Tetrallogy of Fallot （TOF） under 3 years of age with SpO2 〈 85% underwent one stage repairing operations were divided into 3 groups： G1 （n = 30） , experimental group 1, PaO2 at the beginning and during CPB was maintained below 130 mmHg before CPB rewarming phase; G2（ n = 30）, experimental group 2, PaO2 at the beginning and during CPB was controlled between 250 - 300 mmHg before CPB rewarming phase ; G3 （ n = 30）, control group, PaO2 during CPB was maintained between 450 -500 mmHg. Myocardial enzymes and cTnⅠ were measured before CPB, 10 min after CPB, 10 min after cross clamp releasing （CCR） , 6 hrs and 24 hrs post operation with peripheral blood samples. RESULTS CK- MB ,LDH and cTnⅠ had no significantly different between 3 groups preoperatively and 10 min after CPB among 3 group. At 10 min after CCR, 6 hrs and 24 hrs post operation, KMB, LDH and cTnⅠ in G1 were significantly lower than that in G3 （ P 〈0.01 orP 〈0.05）. At 24 hrs post operation, also cTnⅠ in G1 was significantly lower than that in G2（ P 〈0.05）. At 10min after CCR, CKMB in G2 was significantly lower than that in G3 （ P 〈0.05）. At 6hrs post operation, cTnⅠ in G2 was signifieantly lower than that in G3 （ P 〈 0.05 ）. CONCLUSION During CPB controlling PaO2 to a preoperative low level would reduce releasing enzymes of myocardial and eTnI in cyanotic congenital heart disease.

关 键 词：紫绀 先天性心脏病 体外循环 氧分压 

分 类 号：R726.5[医药卫生—儿科]