体外循环对小儿先天性心脏病患者血浆神经肽的影响和意义

Effect and its significance of cardiopulmonary bypass on plasma concentration of neuropeptides in children with congenital heart disease

目的:探讨体外循环(Cardiopulmonary bypass,CPB)对小儿先天性心脏病围手术期神经肽Y(Neuropeptide Y,NPY),P物质(SubstanceP,SP),血管紧张素Ⅱ(AngiotensinⅡ,AngⅡ)和降钙素基因相关肽(Calcitonin gene related peptide,CGRP)血浆浓度的影响和临床意义。方法:选择20例先天性心脏病患儿,分别在转机前,转机中(CPB开始7min),转机后(体外循环停止后即刻)以及手术后12h采集血标本,用放射免疫法测定上述四种神经肽血浆浓度。结果:与转机前相比,转机中以及转机后,NPY、SP、AngⅡ和CGRP浓度均有显著上升(P<0.05),手术后12h,NPY、SP、AngⅡ和GCRP的浓度回落,与转机前无统计学差异(P>0.05)。体外循环时间与转机后神经肽浓度成正相关(P<0.05)。结论:体外循环是一种非生理性灌注,可以导致神经肽含量的明显变化,因而可对机体产生不同的影响。缩短体外循环的时间,保持神经肽的相对平衡,可能对机体的康复有重要意义。

Objective： To explore the effect of cardiopulmonary bypass on the concentration of neuropeptide Y（NPY） , Substance P（SP） , angiotensin Ⅱ （ Ang Ⅱ ） and calcitonin gene relative peptide （CGRP） during cardiopulmonary bypass in child heart surgery , and to determine their clinical significance.Methods： 20 children with congenital heart disease were chosen in hospital. Blood samples were taken from central vein to determine the concentration of NPY, SP, CGRP, and Ang 11 in plasma by radioimmunoassay before CPB, during CPB at 7min,at the termination of CPB,and 12 hours after-opertation.Results：The concentration of NPY,SP,Ang Ⅱ and CGRP increased significantly during CPB and at the termination of CPB （P〈0.05）,and restored to baseline at 12h after operation with no significant difference form pre-cardioplumonary bypass （P〉0.05）. The duration of CPB had positive correlation with the concentration of peptides （P〈0.05）. Conclusions： Cardiopulmonary bypass is a non-physiological perfusion, The change of peptides is a compensational reaction to cardiopulmonary bypass.Reducing the time of cardiopulmonary bypass and keeping relative balance of peptides may have important significance for recovering from illness.