摘要
目的 对先天性心脏病（CHD）婴幼儿体外循环（CPB）时动脉血氧分压（PaO2）与脑损伤的关系进行前瞻性研究.方法 2010年8月1日至2011年1月31日在广东省人民医院住院的发绀型CHD婴幼儿45例,年龄0～3岁、脉搏血氧饱和度＜85％,随机分为3组：控制组1（G1组）,控制组2（G2组）和非控制组（G3组）,每组15例,在CPB过程中分别全程控制PaO2在80～120 mmHg（1 mm Hg=0.133 kPa）、120 ～200 mm Hg和200～ 400 mm Hg.3组患儿除观察因素PaO2外,其他因素基本一致,于CPB前（T1）、CPB刚结束时（T2）以及CPB结束后3、5、24 h（T3,T4,T5）采血检测S-100β蛋白、神经元特异性烯醇化酶（NSE）和肾上腺髓质素（ADM）.结果 S-100β蛋白在CPB开始后明显升高,以G3组在T2时间点最为明显,高达（699±139） ng/L,显著高于G1组[（528±163） ng/L]和G2组[（585±155）ng/L].对S-100β水平与PaO2进行偏相关分析,结果提示两者呈显著的正相关关系（r =0.526,P＜0.01）.G1组NSE在T3、T4时间点显著升高[（12.2±3.4） μg/L和（ 12.3±3.7）μg/L]；G2组在CPB刚结束时即已有显著升高[（10.9 ±4.8）μg/L],在T3、T4时间点可见进一步升高[ （12.6±5.1）μg/L和（13.2±5.4）μg/L]；G3组在CPB结束时见显著升高,在CPB后24h仍维持在较高水平[（12.2±5.7）μg/L],无明显下降趋势.在同一观察组不同时间点以及同一时间点不同观察组之间ADM差异均无统计学意义.3组患儿均痊愈出院.结论 发绀型CHD患儿CPB过程中高氧灌注可引起S-100β蛋白、NSE血清水平增高,提示PaO2过高可能会引起脑组织损伤加重,并且其损伤程度与组织灌注的PaO2呈正相关.
Objective A prospective study was conducted to probe into the relationship between arterial oxygen partial pressure （ PaO2 ） and brain injury during cardiopulmonary bypass （CPB） in infants with cyanotic congenital heart disease （CHD）.Method Enrolled in the study were 45 cyanotic infants,who were less than three years old and underwent corrective cardiac surgery from August 1st,2010 to January 31st,2011 at Guangdong General Hospital.All the infants had a pulse oxygen saturation （SpO2 ） lower than 85% and were randomly allocated into three groups by a specific computer program.In controlled group 1（G1 group）,PaO2 levels were controlled at 80 - 120 mm Hg （1 mm Hg =0.133 kPa） during CPB; in controlled group 2 （G2 group）,PaO2 levels at 120 -200 mm Hg during CPB; while in uncontrolled group （G3 group）,PaO2 levels were at 200 -400 mm Hg during CPB.Blood samples were collected just before starting CPB,at the end of CPB,and at 3 h,5 h,and 24 h after CPB （T1,T2,T3,T4,T5 ） for the determination of serum concentrations of protein S100β,neuron specific enolase （NSE）,and adrenomedulin （ADM） by ELISA.Result Protein S100β rose significantly after starting CPB.In group G3,it reached a peak of （699 ± 139） ng/L by the end of CPB,significantly higher than those in groups G1 and G2 [ （528 ±163 ） ng/L and （585 ± 155 ） ng/L],and was positively correlated with PaO2 levels （r =0.526,P 〈 0.01 ）.NSE levels of group G1 were continuously rising after starting CPB and reached significantly high levels at 3 hor5 h after CPB [（12.2 ±3.4） μg/L and （12.3 ±3.7） μg/L],while those of group G2 rose significantly during CPB [ （ 10.9 ±4.8） μg/L] and even higher at 3 h or 5 h after CPB [ （ 12.6 ±5.1 ） μg/Land （13.2 ±5.4）μg/L].NSE levels of group G3 rose significantly during CPB and maintained at a high level [ （12.2 ± 5.7）μg/L] afterwards.There was no significant difference in serum ADM concentrations among different time points in each group and among these three groups.All the infants were discharged from the hospital without any obvious nervous symptom and sign.Conclusion High PaO2 during CPB in infants with CHD might cause an increase of serum protein S100β and NSE,indicating that brain injury might become worse with a higher PaO2 and might be positively correlated with PaO2 during CPB.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2012年第2期121-125,共5页
Chinese Journal of Pediatrics
基金
基金项目：国家科技支撑计划课题（2006BA101A08）
广东省重点科技项目（2005833801008）
广东省重点科技项目（20078031507009）
