新生儿体外循环心脏术后肺表面活性物质的变化及临床意义  

Pulmonary surfactant changes and its clinical significance after cardiopulmonary bypass in neonates with congenital heart disease

作　　者：张荣媛[1] 王旭[1] 李守军[2] 闫军[2] 朱啸淳 杨菊先[1] 曾敏[1] 李胜利[1] 段雷雷[1] 

机构地区：[1]中国医学科学院阜外心血管病医院小儿心脏中心PICU,100037 [2]中国医学科学院阜外心血管病医院外科,100037

出　　处：《中华小儿外科杂志》2015年第6期430-434,共5页Chinese Journal of Pediatric Surgery

基　　金：中央级公益性科研院所基金（2013-F19）

摘　　要：目的 通过测定肺表面活性物质相关蛋白（SP-A）在新生儿复杂先天性心脏病（先心病）术后不同时间点含量的动态变化,初步探讨SP-A含量变化及临床意义.方法 分析25例新生儿接受复杂先心病术后早期SP-A含量变化及临床资料.其中,男19例,女6例;年龄7～30 d,平均20.9 d;体重2.6～4.6kg,平均3.8 kg;先心病手术风险矫正评分（RACHS-1）分级等级位列2～4级.应用酶联免疫吸附剂分别在术后2、12、24、72和120h 5个不同时间点测定患儿血清中SP-A的含量,根据患儿在ICU滞留是否大于7d分为滞留组（8例）和对照组（17例）,比较两组术后SP-A含量变化及临床意义.结果 新生儿在体外循环下接受复杂畸形心脏矫治手术后2～120 h,血浆中SP-A的浓度呈时间依赖性递增,其中12h和72 h表现为2个增长点.滞留组患儿平均年龄（13.0±4.1）d、平均体重（2.4±0.6）kg均小于对照组的平均年龄（25.6±4.7）d和平均体重（4.9±2.2）kg,滞留组患儿的手术平均阻断时间（94±22）min和转机时间（181±18）min长于对照组的阻断时间（62±16）min和转机时间（120±14）min,滞留组患儿术后呼吸机辅助平均辅助时间（8.2±7.3）d长于对照组患儿术后呼吸机平均辅助时间（1.5±0.9）d,滞留组患儿术后并发症发生率（50.0％）高于对照组患儿术后并发症发生率（5.9％）,差异均有统计学意义（P＜0.05）.滞留组患儿血清中SP-A的含量自术后12h起明显高于对照组,SP-A术后12h的浓度与ICU滞留时间有很强的相关性.结论 新生儿在体外循环下接受复杂畸形心脏矫治手术后血清SP-A浓度增高,SP-A浓度越高,越容易发生ICU滞留,SP-A是一种潜在的新型肺泡毛细血管损伤的生物标志物.Objective To determine whether or not the changes of surfactant occur in neonates undergoing condiopulmonary bypass （CPM） surgery.Methods A total of 25 infants with congenital heart disease aged under 30 days were recruited.There were 19 males and 6 females with an average age of 20.9 （7-30） days and an average weight of 3.8 （2.6-4.6） kg.The grades of Risk Adjustment for Congenital Heart Surgery-1 （RACHS-1） were Ⅱ-Ⅳ.Blood samples were collected from 25 patients and serial plasma concentrations of surfactant protein A （SP-A） measured with enzyme-linked immunosorbent assay.They were divided into delayed （n =8） and control （n =17） groups according to whether or not the duration of intensive care unit （ICU） was longer than 7 days.Results At 2-120 h post-operation,the plasma concentration of SP-A increased time-dependently,including two peaks at 12 and 72 h.The average age and body weight of delayed group were less than those of control group （13.0 ± 4.1 vs 25.6 ± 4.7 days; 2.4 ± 0.6 vs 4.9 ± 2.2 kg）.And operative blockage time and CPB were longer in delayed group than control group （94 ± 22 vs 62 ± 16 min; 181 ± 18 vs 120 ± 14 min）.The mean mechanical ventilation time was longer in delayed group than control group （8.2 ± 7.3 vs 1.5 ± 0.9 days）.There was a higher incidence of postoperative complications in delayed group than control group （50.0％ vs 5.9％,P＜0.05）.The serum level of SP-A after 12h was significantly higher in delayed group than that in control group.And a strong correlation existed between the level of SP-A after 12h and ICU duration.Conclusions The serum concentration of SP-A increases after CPB in neonates.The higher concentration of SP-A,the more a patient is prone to ICU retention.Thus SP-A is a new type of biomarker for alveolar capillary injury.

关 键 词：心血管畸形 心脏病 体外循环 肺表面活性剂 

分 类 号：R726.5[医药卫生—儿科]