摘要
目的探讨和评估体外循环对婴幼儿肝脏的影响。方法选取20例15kg以下先心病患儿，在体外循环（CPB）下进行先心病纠治术，CPB结束后行改良超滤（MUF）。分别在手术开始、主动脉阻断时、主动脉开放、CPB结束时、MUF后、术后2h、术后20h七个时间点抽取血液样品来检测其丙氨酸氨基转移酶（ALT），天门冬氨酸氨基转移酶（AST），血清碱性磷酸酶（ALP），总蛋白（TP）和乳酸（Lac）。结果手术开始时，因血液稀释除Lac外，其余指标的数值均下降（P〈0．01）。ALT在主动脉阻断后至术后20h逐渐升高，并大于术前（P〈0．01），AST的变化类似于ALT，但上升幅度远超过ALT。ALP与TP术中变化平稳，术后有所上升，但直至术后20h仍低于术前水平（P〈0．01）。Lac在主动脉阻断时达到最高峰（P〈0．01），术中仅有少量下降，但MUF过程中Lac值明显降低（P〈0．01）。结论体外循环对肝脏功能有一定损伤，MUF能有效降低乳酸值，可在一定程度上促进肝功能的恢复。
Objective To investigate and evaluate the influence of cardiopulmonary bypass （CPB） on infant＇s liver. Methods 20 patients of congenital heart disease under 15 kg were enrolled,underwent repair operation under CPB and modified ultrafiltration （MUF） after CPB. The blood samples were collected to observe the changes in ALT,AST,ALP,TP and Lac at 7 different time points, including operation start, aorta clamping, aorta decamping, CPB off, MUF off, post-op 2 h and post--op 20 Hrs. Results At the point of operation start,except for Lac,the other indexes decreased for hemodilution （P 〈 0. 01）. The ALT gradually elevated from aorta clamping to post-op 20 h,and significantly higher than pre-op index （P〈 0. 01）. The change of AST was similar to that of ALT, but the rising amplitude was greater. The ALP and TP were smoothly changed during operation,and slightly elevated after operation, but still lower than pre-op level until post-op 20 h （P〈0. 01）. The Lac reached the peak value at the point of aorta clamping （P〈0. 01） ,and slightly decreased during op- eration,but significantly decreased during MUF process （P〈0. 01）. Conclusion The hepatic function was really injuried during cardiopulmonary bypass process. MUF could effectively remove LAC and promote the recovery of hepatic function in some degree.
出处
《现代检验医学杂志》
CAS
2009年第6期109-111,共3页
Journal of Modern Laboratory Medicine
关键词
体外循环
婴幼儿
肝功能
eardiopulmonary bypass
infants
liver function
