去白细胞冷自体血停搏液减轻婴儿体外循环心脏手术心肌损伤作用的研究  

Effect of leucocyte-depleted autologous cold blood cardioplegia on myocardial injury in infants undergoing heart surgery with cardiopulmonary bypass

作　　者：王元祥[1] 周晓东 孟保英[1] 刘怀普[1] 张程 丁以群[1] Wang Yuanxiang;Zhou Xiaodong;Meng Baoying;Liu Huaipu;Zhang Cheng;Ding Yiqun(Department of Cardiothoracic Surgery,Shenzhen Children's Hospital of Chinese Medical University,Guangdong Shenzhen 518026,China)

机构地区：[1]深圳市儿童医院,深圳518026

出　　处：《中国体外循环杂志》2018年第6期330-333,共4页Chinese Journal of Extracorporeal Circulation

基　　金：深圳市卫生计划系统科研项目(SZXJ2018044);深圳市医疗卫生三名工程项目(SZSM201612003)

摘　　要：目的监测婴儿体外循环心脏病手术采用不同停搏液灌注前后不同时间点血清心脏脂肪酸结合蛋白(HHFABP)、肌钙蛋白I(c Tn I)及磷酸肌酸激酶同工酶(CKMB)的变化,探讨去白细胞冷自体血停搏液对减轻婴儿体外循环心脏手术心肌损伤的作用。方法采用临床对照研究,将年龄≤10月;体质量≤8 kg的100例患儿分为去白细胞冷自体血停搏液组(实验组)和冷自体血停搏液组(对照组)。分别于体外循环前及主动脉开放后30 min,1 h,6 h,12 h,24 h检测血清中HHFABP、c Tn I及CKMB的水平,超声检查获得对应时间点的左室射血分数(LVEF)。结果术前实验组和对照组HH-FABP、c Tn I、CKMB及LVEF差异无统计学意义,实验组术后各时间点HH-FABP、c Tn I及CKMB峰值均低于对照组,LVEF值高于对照组,HH-FABP峰值出现在术后1 h,c Tn I及CKMB峰值出现在术后24 h及12 h。结论去除冷自体血停搏液中白细胞可减轻婴儿体外循环心脏直视手术中心肌的损伤。Objective By monitoring the levels of HH-FABP,cTnI and CKMB at different time points before and after cardiac surgery with cardiopulmonary bypass,so as to evaluate the effect of leucocyte-depleted autologous cold blood cardioplegia on myocardial protection in infants. Methods A total of 100 infant patients were divided into two groups. Fifty patients were given leucocyte-depleted autologous cold blood cardioplegia as experimental group,while the other 50 patients were given autologous cold blood cardioplegia as control group. The levels of HH-FABP,cTnI and CKMB in blood were examined before CPB and at 30 minutes,60 minutes,12 hours,24 hours after the removal of the aortic clamp. Also,the LVEF was checked accordingly. Results There was no significant difference between the two groups before aortic cross clamp removal. The levels of HH-FABP,cTnI and CKMB of experimental group were significantly lower than those in control group,while the LVEF levels were higher. The levels of HH-FABP in both groups arrived peak values 60 minutes after aortic cross clamp removal. While the levels of cTnI and CKMB in both groups arrived the peak values 24 h and 12 h after aortic cross clamp removal. Conclusion The leucocyte-depleted autologous cold blood cardioplegia is effective to decrease myocardium injury of infants undergoing open-heart surgery with cardiopulmonary bypass.

关 键 词：去白细胞 体外循环 人心脂肪酸结合蛋白 肌钙蛋白I 磷酸肌酸激酶同工酶 

分 类 号：R726.5[医药卫生—儿科]