重症法洛四联症患儿行改良B-T分流术后心功能及4种血清学指标水平变化  

Changes of cardiac function and four serological indexes in patients with severe tetralogy of Fallot after modified Blalock-Taussig shunt

作　　者：王鹏高 陈忠建 崔亚洲 于文波[1] WANG Penggao;CHEN Zhongjian;CUI Yazhou;YU Wenbo(Department of Thoracic and Cardiovascular Surgery,Zhengzhou Children’s Hospital,Henan Children’s Hospital,Children’s Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属儿童医院河南省儿童医院郑州儿童医院胸心外科

出　　处：《中华实用诊断与治疗杂志》2019年第11期1082-1084,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省科技厅科技攻关项目(162102310224)

摘　　要：目的探讨重症法洛四联症患儿行改良B-T分流术后血清脑损伤、心肌损伤指标水平变化,随访观察心功能改善情况及手术效果。方法重症法洛四联症患儿73例,均于常温非体外循环下行改良B-T分流术。检测术前及术后12h血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)、神经组织蛋白质S100-β、肌钙蛋白I(cardiac tropnin I,cTnI)、肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB);分别于术前及术后6、12、18、24个月行超声心动图检查,测定左室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期容积指数(left ventricular end-diastolic volume index,LVEDVI),计算McGoon比值。结果术后12h血清NSE[(8.06±1.14)μg/L]、S100-β[(0.12±0.03)μg/L]、cTnI[(0.55±0.19)μg/L]、CK-MB[(10.11±1.24)u/L]水平与术前[(7.79±1.30)μg/L、(0.11±0.04)μg/L、(0.53±0.21)μg/L、(9.76±1.02)u/L]比较差异无统计学意义(P>0.05);术后6、12、18、24个月LVEF[(63.46±5.61)%、(66.41±6.36)%、(66.08±5.64)%、(65.89±5.71)%]与术前[(65.31±1.34)%]比较差异无统计学意义(P>0.05),LVEDVI[(49.07±2.02)、(50.02±2.51)、(48.81±2.33)、(49.07±2.28)mL/m^2]、McGoon比值(1.41±0.10、1.37±0.12、1.31±0.15、1.35±0.13)较术前[(28.02±1.71)mL/m^2、1.04±0.04]增高(P<0.05);术后随访24个月,住院期间死亡2例,失访2例,余69例中66例行法洛四联症根治术取得良好效果,3例再次行改良B-T分流术治疗。结论重症法洛四联症患儿行改良B-T分流术治疗可促进左心室发育,且不会造成左心室扩张过度,对心肌、脑损伤程度较轻微,可使患儿及早达到标准行根治术,改善预后。Objective To investigate the changes of serum brain injury indexes and myocardial injury indexes after modified Blalock-Taussig(B-T)shunt in children with severe tetralogy of Fallot,and to observe the improvement of cardiac function and surgical outcome.Methods Seventy-three children with severe tetralogy of Fallot received modified B-T shunt under normal temperature without cardiopulmonary bypass.Serum neuron specific enolase(NSE),S100-β,cardiac troponin I(cTnI)and creatine kinase isoenzyme(CK-MB)were detected before and 12 h after surgery.The left ventricular ejection fraction(LVEF)and left ventricular end-diastolic volume index(LVEDVI)were measured by echocardiography before and in 6,12,18 and 24 months after surgery,respectively,and the McGoon ratio was calculated.Results There were no significant differences in the serum levels of NSE((8.06±1.14)μg/L vs.(7.79±1.30)μg/L),S100-β((0.12±0.03)μg/L vs.(0.11±0.04)μg/L),cTnI((0.55±0.19)μg/L vs.(0.53±0.21)μg/L)and CK-MB((10.11±1.24)u/L vs.(9.76±1.02)u/L)in 12 h after surgery compared with those before surgery(P>0.05).LVEF scores showed no significant differences in 6,12,18 and 24 months after surgery((63.46±5.61)%,(66.41±6.36)%,(66.08±5.64)%,(65.89±5.71)%)compared with those before surgery((65.31±1.34)%)(P>0.05).LVEDVI((49.07±2.02),(50.02±2.51),(48.81±2.33),(49.07±2.28)mL/m^2)and McGoon ratio(1.41±0.10,1.37±0.12,1.31±0.15,1.35±0.13)in 6,12,18 and 24 months postoperatively were higher than those before surgery((28.02±1.71)mL/m^2,1.04±0.04)(P<0.05).All patients were followed up for 24 months except 2 deaths in hospital and 2 lost.In the 69 survived patients,66 obtained satisfied outcomes after radical operation,and the other 3 were performed modified B-T shunt.Conclusion The modified B-T shunt can promote the development of left ventricle in children with severe tetralogy of Fallot without causing excessive left ventricular dilatation.With slight affect on myocardium and brain,it can help the patients to reach the standard of treatment an

关 键 词：重症法洛四联症 改良B-T分流术 心功能 神经元特异性烯醇化酶 神经组织蛋白质S100-β 肌钙蛋白I 肌酸激酶同工酶 

分 类 号：R54[医药卫生—心血管疾病]