全腔静脉-肺动脉连接术后胸腔积液与心血管活性肽的关系

The relationship of hydrothorax in patients after total cavopulmonary connection with vasoactive peptide

目的 探讨心外管道全腔静脉 -肺动脉连接术 (TCPC)后胸腔积液并发症的危险因素及其与心血管活性肽之间的关系。 方法 将 2 4例行心外管道 TCPC后患者胸腔引流液量作为因变量 ,年龄、Nakata指数、射血分数、人工血管直径、平均肺动脉压、中心静脉压 (CVP)作为自变量 ,建立多元线性回归方程 ,同时在术后第 1、3、5和 7天测量内皮素 - 1(ET- 1)、降钙素基因相关肽 (CGRP)的变化。 结果 经回归方程线性假设检验 ,胸腔引流液量与 CVP呈直线正相关 (F=6 85 .6 0 0 ,P<0 .0 1,其回归方程为 Y=0 .5 98X- 3.4 30 ,r=0 .985 ) ,而与其它因素无明显相关关系。CVP与 ET- 1呈显著正相关 (r=0 .982 ,P<0 .0 5 ) ,与 CGRP呈显著负相关 (r=- 0 .986 ,P<0 .0 5 )。 结论 在严格掌握手术适应证的前提下 ,CVP增高是胸腔积液并发症发生的独立危险因素 ;而术后早期肺血管内皮细胞对 ET- 1和CGRP引起的分泌紊乱 ,可能是导致 CVP升高继而引起胸腔积液并发症的原因之一。

Objective To analyze the risk factors of hydrotho rax in patients und erwent extracardiac conduit total cavopulmonary connection (TCPC), and to study its re lationship with cardiovascular active peptides. Methods Twent y-four patients we re analyzed, the volume of hydrothorax drainage was selected as the dependent va riable; the age, Nakata index, ejection fraction,artificial blood vessel's diameters, mean pulmonary artery pressure and central venous pressure(CVP) were selected as the independent variables; and the multi-linear regression was crea ted. Endothelin-1 (ET-1) and calcitonin-gene-related peptide (CGRP) were mea sured in 1st , 3rd, 5th and 7th day after the operation. Results The draina ge increased progressively with the increase of CVP (Hypothesis testing of regre ssion equation F=685.600, P<0.01; Regression equation Y=0.5 98X-3.430,r=0.985). CVP has a positive correlation with ET-1 (r=0. 982,P<0.05), and has a negative correlation with CGRP (r=-0.986,P <0.05). Conclusion On the premise of strictly gras ps of the indication, high pressure of CVP is the independent risk factor lea ding to hydrothorax. The excretion derangement of ET-1 and CGRP on the early pe riod after operation may be causes of high pressure of CVP and will result in hy drothorax.