体外循环对先天性心脏病合并肺动脉高压患者血浆NO和ADMA浓度的影响

Effects of cardiopulmonary bypass on plasma nitric oxide and asymmetric dimethyl arginine concentrations in patients with congenital heart disease complicated with pulmonary hypertension

目的通过观察体外循环（CPB）对先天性心脏病合并肺动脉高压患者血浆一氧化氮（NO）和不对称二甲基精氨酸（ADMA）浓度的影响，分析CPB加重肺动脉高压的原因。方法拟在CPB下行心内修补术的先天性心脏病患者18例，年龄11—40岁，体重26～59kg，ASAⅡ或Ⅲ级，心功能Ⅰ-Ⅲ级。根据术前肺动脉收缩压（PASP）分为3组（n=6），Ⅰ组肺动脉压正常（PASP〈30mmHg）；Ⅱ组肺动脉压轻度增高（PASP30～50mmHg）；Ⅱ组肺动脉压中重度增高（PASP〉50mmHg）。分别于麻醉诱导前（基础状态）、CPB开始即刻、CPB停机后即刻、3、6和24h时采集桡动脉血样4ml，测定血浆NO和ADMA浓度。结果与基础值相比，Ⅱ组和Ⅲ组CPB停机后即刻、3和6h时血浆ADMA浓度升高，NO浓度降低（P〈O．05），Ⅰ组上述指标差异无统计学意义（P〉0．05）。与Ⅰ组比较，Ⅱ组和Ⅲ组血浆NO浓度降低，ADMA浓度升高（P〈0．05）。结论CPB可引起先天性心脏病合并肺动脉高压患者血浆ADMA浓度升高，NO浓度降低。

Objective To investigate the effects of cardiopulmonary bypass （CPB） on plasma nitric oxide （NO） and asymmetric dimethyl arginine （ADMA） concentrations in patients with congenital heart disease complicated with pulmonary hypertension undergoing open heart surgery. Methods Eighteen ASA Ⅱ or Ⅲ patients aged 11-40 yr weighing 26-59 kg undergoing open heart surgery under CPB were divided into 3 groups according to pulmonary arterial systolic pressure （PASP） （n = 6 each）： group Ⅰ PASP 〈 30 mm Hg; group n PASP 30-50 mm Hg and group m PASP 〉 50 mm Hg. Arterial blood samples were taken before induction of anesthesia （TO , baseline）, at the start and termination of CPB （T1,2） and 3, 6, 24 h after CPB （T3,5 ） for determination of plasma NO and ADMA Results The three groups were comparable with respect to M/F sex ratio age, body weight and CPB time. The plasma ADMA concentrations were significantly increased while NO concentrations were significantly decreased at termination of CPB （T2） and 3 and 6 h after CPB （T3,4） as compared with the baseline at TO in group Ⅱ and Ⅲ. The plasma ADMA concentration were significantly higher and NO concentrations were significantly lower at all time points in group Ⅱ and Ⅲ than in group Ⅰ . Conclusion CPB can increase plasma ADMA concentration and decrease plasma NO concentration in patients with congenital heart disease complicated with pulmonary hypertension undergoing open heart surgery.