Fontan术后血浆内皮素-1和肾上腺髓质素的改变研究

Change of Endothelin-1 and Adrenomedullin after the Fontan operation

目的 探讨血浆内皮素-1（ET-1）和肾上腺髓质素（AM）在Fontan手术前后的变化情况及相互关系.方法 随机选择2012年1～6月武汉亚洲心脏病医院行Fontan手术的患儿8例,为Fontan组;另随机选择8例先天性心脏病患儿行双心室修复,为对照组.两组患者术前经超声心动图或心导管检查都排除了继发性肺动脉高压.于体外循环（CPB）前即刻采5ml静脉血测定血浆ET-1和AM水平.术后即刻,术后6h、24h采静脉血测定血浆ET-1和AM的水平.结果 两组血浆ET-1水平于CPB后均升高,在CPB后6h达到峰值,CPB后24h减少.在CPB后6h及24 h,Fontan组与对照组相比,血浆ET-1水平呈显著高值[（8.41±2.28）pg/ml比（5.30±1.17）pg/ml,P=0.004;（8.40±2.28）pg/ml比（2.45±0.70）pg/ml,P=0.031],差异有统计学意义.两组血浆AM水平在CPB后均立即增加,在CPB 6 h后对照组达到峰值.CBP后6h,Fontan组血浆AM水平升高的程度显著低于对照组[（81.50±37.93）pg/ml比（221.00±59.71）pg/ml,P=0.045],24h迅速恢复到CPB前基线水平,与对照组相比表现为显著低值[（72.62±25.07）pg/ml比（174.75±73.33）pg/ml,P=0.000],差异有统计学意义.结论 Fontan手术体外循环后患者ET-1表现出显性效应,可能在Fontan手术后的血管收缩机制中起重要作用.AM参与了Fontan手术后保护机制.

Objective To investigate the time course and mutual relationships of Endothelin-1 and Adrenomedullin before and after the Fontan operation. Methods Eight patients who had Fontan operation in Wuhan Asia Heart Hospital（2012.01-2012.06） were randomly selected into the Fontan group, and another 8 children with congenital heart diseases who had biventrieular repair were set to the control group. Secondary pulmonary hypertension had been excluded by echoeardiography or cardiac catheterization in both two groups. Immediately before cardiopulmonary bypass （CPB）, 5 ml of venous blood was drawn to measure the plasma ET- 1 and AM levels. Plasma ET-1 and adrenomedullin levels were also measured in both groups immediately after operation, and 6 and 24 hours after operation. Results The plasma ET-1 levels increased after CPB, peaked at 6 hours after CPB, and decreased 24 hours after CPB in both groups. However, the plasma ET-1 level in the Fontan group showed a significantly higher value compared with the control group at 6 and 24 hours after CPB [ （8.41±2.28）pg/ml vs （5.30±1.17）pg/ml, P=0.004], [（8.40±2.28）pg/ml vs （2.45±0.70）pg/ml, P=0.031 ]. The difference are statistically significant. The plasma AM levels increased immediately after CPB in both groups and continued to increase after CPB, peaking at 6 hours after CPB. In the Fontan group, the plasma AM level showed significantly lower values compared with the control group at 6 hours after CPB [（81.50±37.93）pg/ml vs （221.00±59.71）pg/ml, P= 0.045] and returned to the baseline level at 24 hours after CPB rapidly[（72.62±25.07）pg/ml vs （174.75±73.33） pg/ml, P=0.000]. The difference also shows statistically significant. Conclusion ET-1 shows dominant effects after cardiopuhnonary bypass in the Fontan operation, which might play an important role in maintaining vasocon- striction after the Fontan operation. AM functions in protective mechanism postoperatively.