先天性心脏病心内直视手术对血浆内皮素的影响

Changes of Plasma Endothelin in the Patients with Congenital Heart Disease Undergoing Open Heart Surgery

目的 探讨先天性心脏病（ＣＨＤ） 围术期血浆内皮素（ＥＴ） 的变化。 方法 将６７ 例行心肺转流术（ＣＰＢ）的ＣＨＤ 患儿按疾病种类不同分为３ 组，室间隔缺损（ＶＳＤ） 组、肺动脉高压（ＰＨ） 组和肺动脉狭窄（ＰＳ） 组；１０ 例正常儿童为对照组。对前３ 组手术前后血浆ＥＴ 变化进行动态观测。 结果 ＰＨ 组和ＰＳ组术前ＥＴ 值即有升高，术后７ 天仍较对照组为高；ＣＰＢ３０ 分钟时各组ＥＴ 值均较术前为低；术前血浆ＥＴ 值与ＰＳ和ＰＨ 程度呈线性相关；ＰＳ组ＣＰＢ 时间和主动脉阻断时间与术后１ 小时ＥＴ 值明显相关。 结论 ＣＨＤ 患儿手术前、后血浆ＥＴ 值均有变化，血浆ＥＴ 水平可作为监测肺动脉压力变化及ＣＨＤ 手术预后的指标之一。

Objective To study the dynamic changes of plasma endothelin(ET) pre and post operatively in the patients with congenital heart disease(CHD). Methods Sixty seven patients undergoing cardiopulmonary bypass (CPB)were divided into 3 groups: Ventricular septal defect group(23 cases),pulmonary hypertension group(20 cases),pulmonary stenosis group(24 cases) and ten normal children were as control group.The plasma endothelin was measured pre operatively,30 minutes during CPB,and l hour,24 hours,3 days,7 days and 1 year post operatively. Results The study demonstrated that values of a plasma ET in pulmonary stenosis group and pulmonary hypertension group were higher than those in ventricular septal defect group except at the point of the lst post operative year.The plasma ET values was lower at CPB 30th minutes than the pre operative level in three groups.There was a linear correlation between ET values and pulmonary stenosis group or pulmonary hypertension group.The results also indicated that there existed close correlation between values of plasma ET at l hour postoperatively and cardiopulmonary bypass time or aortic cross clamping time in pulmonary stenosis group. Conclusion The level of plasma ET can be used to monitor change of pressure of pulmonary artery and act as one of methods estimating operative effect.The main causes leading to the changes of plasma ET and the clinical significance of measuring ET were discussed.