体外循环中梯度控制氧分压对紫绀型先天性心脏病心肌保护的影响

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1、体外循环中梯度控制氧分压对紫绀型先天性心脏病心肌保护的影响作者：陈萍，黄劲松，郭阳娇，宋兴荣，黄克力【摘要】目的探讨体外循环(CPB)中梯度控制动脉氧分压(PaO2)对紫绀型先天性心脏病心肌保护的影响。方法3岁以下经皮血氧饱和度<85%、行根治术的法洛四联症患儿90例，随机分为三组：实验1组(G1组，n=30)以接近患儿术前水平的低氧分压启动CPB并控制CPB中血流复温前的PaO2≤130mmHg，CPB血流复温后使PaO2逐渐升至250～300mmHg;实验2组(G2组，n=30)CPB中PaO2在250～300mmHg启动CPB，血流复温后使PaO2逐渐升

2、至450～500mmHg;对照组(G3组，n=30)CPB中PO2始终控制在450～500mmHg。观察心肌生化改变：于CPB前、CPB10min、升主动脉开放(CCR)10min、术后6h、24h抽外周血检测心肌酶CKMB、LDH活性及cTnI浓度。结果①CKMB：CPB前及CPB10min三组间无差异;CCR10min、术后6h及24hG1组显著低于G3组(P<0.01);CCR10minG2组显著低于G3组(P<0.05)。②LDH：CPB前及CPB10min三组间无差异;CCR10min、术后6h和24hG1组显著低于G3组(P<0.01或

3、P<0.05)。③cTnI：CPB前及CPB10min三组间无差异;CCR10min、术后6h、术后24hG1组显著低于G3组(P<0.01);术后6hG2组cTnI也显著低于G3组(P<0.05)。结论9对于紫绀型先天性心脏病，CPB中PaO2控制在G1组的低水平能减少CKMB、LDH活性及cTnI的释放，改善心肌保护效果。【关键词】紫绀;先天性心脏病;体外循环;氧分压　　Abstract:OBJECTIVEToevaluatetheeffectsofarterialoxygenpartialpressure(PaO2)atthebeginnin

4、gandduringcardiopulmonarybypass(CPB)onmyocardialinjuryofcyanoticcongenitalheartdiseas.METHODS90ChildrendiagnosedTetrallogyofFallot(TOF)under3yearsofagewithSpO2<85%underwentonestagerepairingoperationsweredividedinto3groups:G1(n=30),experimentalgroup1,PaO2atthebeginningandduringCPBwas

5、maintainedbelow130mmHgbeforeCPBrewarmingphase;G2(n=30),experimentalgroup2,PaO2atthebeginningandduringCPBwascontrolledbetween250-300mmHgbeforeCPBrewarmingphase;G3(n=30),controlgroup,PaO2duringCPBwasmaintainedbetween450-500mmHg.MyocardialenzymesandcTnIweremeasuredbeforeCPB,10minafterCPB,

6、10minaftercrossclampreleasing(CCR),6hrsand24hrspostoperationwithperipheralbloodsamples.RESULTSCKMB,LDHandcTnIhadnosignificantlydifferentbetween3groupspreoperativelyand10minafterCPBamong3group.At10minafterCCR,6hrsand24hrspostoperation,KMB,LDHandcTnIinG1weresignificantly9lowerthanthatinG

7、3(P<0.01orP<0.05).At24hrspostoperation,alsocTnIinG1wassignificantlylowerthanthatinG2(P<0.05).At10minafterCCR,CKMBinG2wassignificantlylowerthanthatinG3(P<0.05).At6hrspostoperation,cTnIinG2wassignificantlylowerthanthatinG3(P<0.05).CONCLUSIONDuringCPBcontrollingPaO2toapre