全腔静脉-肺动脉连接术后肺循环无搏动血流对内皮素分泌的长期影响

Effect of Non-Pulsatile Blood Flow on the Secretion of Endothelin 1 in Patients Undergoing Total Cavopulmonary Connection

目的 研究全腔静脉 -肺动脉连接术 ( total cavopulmonary connection,TCPC)术后内皮素 -1 ( endothelin-1 ,ET-1 )的变化情况 ,探讨肺循环无搏动血流对肺内分泌功能的长期影响。 方法 将 2 6例研究对象分为两组 ,实验组 :1 3例心外管道 TCPC术后随访患者 ;对照组 :选择 1 3例房间隔缺损、室间隔缺损心内修复术患者。两组患者分别于术前、术后第 1天、第 5天、出院前和随访时测量 ET-1含量 ;实验组在术前、出院前及随访时右心导管测量心脏指数 ( CI)、肺血管阻力 ( PVR)。 结果 实验组术后早期 ET-1含量显著高于对照组 ,且下降缓慢 ,随访时恢复至正常水平 ;实验组术后 ET-1与 CI呈显著负相关 ( r=-0 .91 ,P<0 .0 5) ,与 PVR呈显著正相关 ( r=0 .90 ,P<0 .0 5)。结论 TCPC术后肺血管内皮细胞能够对肺循环内长期无搏动血流逐渐适应 ,但短期内其刺激 ET-1分泌增加所引起的 PVR升高 ,可能与一些术后早期并发症密切相关。

Objective To study the changes of endothelin 1 (ET 1) in patients underwent total cavopulmonary connection (TCPC), and to find out the effects of non pulsatile blood flow on the secretion function of pulmonary endothelial cells. Methods Twenty six patients were divided into two groups:study group: 13 patients underwent extracardiac TCPC, control group: 13 patients underwent definitive repair for ventricular septal defect or atrial septal defect. Blood samples for measurement of ET 1 were obtained in the pre operation, 1 and 5 days after operation, at discharged, and followed up period in two groups; cardiac index (CI) and pulmonary vascular resistance (PVR) were measured by cardiac catheter in the pre operation, at discharging and followed up period in study group. Results Plasma level of ET 1 was significantly higher in the early period in study group than that in the control group, and returned to normal in followed up period. ET 1 had a positive correlation with PVR ( r =0.90, P <0 05), and a negative correlation with CI after operation in study group ( r =-0.91, P <0.05). Conclusion The pneumoangiogram endothelial cell can be accommodated to the long period of non pulsatile blood flow in pulmonary circulation, but in a short period, the increase of ET 1 secretion may lead to the increase of PVR, this may have correction with some early complications.