心脏跳动下心内直视手术对可溶性内皮细胞间黏附分子-1的影响

Effects of Beating Open Heart Surgery on Intercellular Adhesion Molecule-1

目的：对比观察心脏跳动下与心脏静止时心内直视手术对可溶性内皮细胞间黏附分子-１的影响。 方法：35例体外循环心内直视手术的患者分为心脏跳动组（ｎ＝１７，术中不阻断升主动脉，体外循环中鼻咽温度为３２℃～３４℃）和心脏静止组（ｎ＝１８，术中阻断升主动脉，体外循环中鼻咽温度为２５℃～２７℃），动态观察围术期血液可溶性内皮细胞间黏附分子-１的水平变化。 结果：心脏跳动组可溶性内皮细胞间黏附分子-１水平从转流毕到术后２４ｈ均高于心脏静止组，有显著性差异（Ｐ＜０.０５或Ｐ＜０.０１＝。 结论：心脏跳动下心内直视手术由于其高灌注流量和较高的体外循环温度对机体创伤较大，对可溶性内皮细胞间黏附分子-１的水平影响也较严重。从保护血管内皮细胞的角度，我们推崇传统的术中阻断升主动脉的方法。

Objective:To investigate the effects of beating or static open heart surgery on intercellular adhesion molecule 1(ICAM 1). Methods:Thirty five open heart surgery patients were divided into beating heart group(n=17) and static heart group(n=18). The parameters of intercellular adhesion molecule 1 were obtained during the perioperative period. Results:The changes were significant at perioperation between the groups(p<0.05 or p<0.01). Conclusion:Beating open heart surgery had a more unwanted effect on intercellular adhesion molecule-1 because of its larger blood perfusion and higher cardiopulmonary bypass temperature. Clamping the ascending aorta and arresting the heart at operation are recommended.