先天性心脏病患儿心肺转流术后肠道损伤机制及治疗进展  

Mechanism and Treatment of Intestinal Injury After Cardiopulmonary Bypass in Children with Congenital Heart Disease

作　　者：刘晓旭 莫绪明[1] LIU Xiaoxu;MO Xuming(Department of Thoracic&Cardiovascular Surgery,Children’s Hospital of Nanjing Medical University,Nanjing 210008,Jiangsu,China)

机构地区：[1]南京医科大学附属儿童医院心胸外科,江苏南京210008

出　　处：《心血管病学进展》2023年第6期501-505,共5页Advances in Cardiovascular Diseases

基　　金：国家自然科学基金(81970265);国家重点研发计划课题(2021YFC2701002);省部共建临床医学研究中心培育计划(2019060007)。

摘　　要：先天性心脏病(CHD)是新生儿最常见的出生缺陷之一,其中部分CHD需在心肺转流术(CPB)辅助下外科手术矫正。CPB在手术过程中通过人工装置暂时替代患者心肺功能,会影响患儿全身的血液循环,尤其影响患儿肠道的血流灌注,导致线粒体功能障碍、钠钾泵调节功能减弱和细胞内酸中毒,破坏肠道屏障,使内毒素及细菌从肠道转移至血流中,导致肠道功能紊乱,最终影响患儿的预后。如何积极地防治CPB造成的肠道功能损伤是当前临床医生面临的一大难题,有研究发现,改善肠道血流灌注、抑制肠道炎症、调节肠道菌群可减轻肠道损伤,改善预后。现对经历CPB的CHD患儿肠道损伤机制及应对措施展开综述。Congenital heart disease(CHD)is one of the most common birth defects in newborns,some CHD needs surgical correction assisted by cardiopulmonary bypass(CPB).CPB is a special technique that temporarily replaces the patients’cardiopulmonary function with artificial devices during surgery,thus influencing the patients’systemic blood circulation,especially the intestinal blood perfusion.These result in mitochondrial and sodium potassium pump malfunction and intracellular acidosis,which destruct the intestinal barrier and allow endotoxins and bacteria to transfer from intestinal to the bloodstream,leading to intestinal dysfunction and eventually affecting the prognosis of children.How to actively prevent and cure the intestinal function injury caused by CPB is a major problem faced by clinicians at present.Some studies have found that improving intestinal blood perfusion,inhibiting intestinal inflammation and regulating intestinal flora can reduce intestinal injury and improve patients’prognosis.This paper reviews the mechanism and countermeasures of intestinal injury in children with CHD undergoing CPB.

关 键 词：先天性心脏病 心肺转流术 肠缺血再灌注 肠黏膜屏障 肠道菌群 

分 类 号：R726.5[医药卫生—儿科]