内皮素受体拮抗剂对Fontan手术患者近期转归影响的前瞻性研究  

Effect of Endothelin Receptor Antagonists on Recent Outcomes of Patients Undergoing Fontan Surgery: A Prospective Study

作　　者：尚小珂[1] ZhongLiang 丁珊珊[4] 张刚成[1] 卢蓉[1] 

机构地区：[1]武汉亚洲心脏病医院心外科,武汉430022 [2]新加坡国立心脏中心 [3]新加坡国立心脏研究所国立大学医学研究院,新加坡169609 [4]华中科技大学同济医学院附属协和医院肿瘤中心,武汉430022

出　　处：《中国胸心血管外科临床杂志》2015年第3期206-210,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：湖北省卫生厅科研项目(JX6B90);武汉市卫生局科研项目(WX13C47)~~

摘　　要：目的研究内皮素受体拮抗剂对Fontan手术患者近期转归的影响。方法选取2009年1月至2010年12月于武汉亚洲心脏病医院行Fontan手术的患者39例,男25例、女14例,年龄2.5~18.0（8.02±4.98）岁。按照病案号单双号将患者分为内皮素受体拮抗剂组（波生坦组,n=16）和对照组（n=23）。波生坦组在术后3 d内按照推荐剂量开始灌胃（口服）波生坦,对照组不应用任何肺动脉高压靶向治疗药物,用药时间≥7 d。术后第10 d比较两组患者的死亡率等指标。结果波生坦组无死亡,对照组于术后第5 d死亡1例,两组术后死亡率差异无统计学意义（P〉0.05）。术后第10 d波生坦组患者在心功能、胸腔积液发生率、血管活性药物评分和血清B型脑钠肽、白蛋白、谷丙转氨酶方面均显著优于对照组（P〈0.05）,而两组6分钟步行距离、经皮血氧饱和度、血白细胞、C反应蛋白、肌钙蛋白I、肌酐差异无统计学意义（P〉0.05）。结论内皮素受体拮抗剂能够改善患者Fontan术后的近期转归。Objective To study the effect of endothelin receptor antagonist on recent outcome of patients undergoing Fontan surgery. Methods Thirty nine patients who received Fontan procedure from January 2009 to December 2010 in Wuhan Asia Heart Hospital were recruited in the study. There were 25 males and 14 females with mean age of 8.02±4.98 years（ranged from 2.5 to 18.0 years）. According to the admission number, the patients were randomly divided into an endothelin receptor antagonists group（bosentan group, n=16） and a control group（n=23）. The bosentan group received bosentan treatment by gastric fill or oral according to the recommended dose in three days after surgery for over 7 days. The control group did not receive any pulmonary hypertension targeted therapy. On the 10 th day after surgery, indexes including mortality etc in the two groups were compared. Results No death occurred in the bosentan group. One patient died on the 5th day after operation in the control group. There was no significant difference in the postoperative mortality. The patients in the bosentan group got significantly better results than the control group in cardiac function, incidence of pleural effusion, vasoactive drugs score, and serum B-type natriuretic peptide, albumin, alanine aminotransferase on the 10 th day（P〈0.05）; while the 6-minute walk distance, transcutaneous oxygen saturation, white blood cell count, C-reactive protein, cardiac troponin I, and creatinine of the two groups showed no statistical difference（P〉0.05）. Conclusion Endothelin receptor antagonists can improve the short-term outcome of patients after Fontan surgery.

关 键 词：内皮素受体拮抗剂 FONTAN手术 全肺阻力 波生坦 

分 类 号：R654.2[医药卫生—外科学]