全腔静脉肺动脉连接术后内皮素分泌的随访研究

Follow-up study of endothelin-1 in patients undergoing total cavopulmonary connection

目的 通过全腔静脉肺动脉连接术后内皮素 1 (ET 1 )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 试验组为 1 8例行全腔静脉肺动脉连接手术后随访病人 ;对照组选择1 8例房间隔缺损、室间隔缺损心内修复术病人。两组分别于术前、术后第 1、5d、出院前和随访时测定ET 1含量。试验组术前、出院前及随访时还行右心导管检查测量心脏指数 (CI)及肺血管阻力 (PVR)。结果 试验组ET 1含量在术后早期显著高于对照组 ,且下降缓慢 ,随访时才恢复至正常水平。试验组术后ET 1含量与CI呈显著负相关 (r=- 0 92 ,P <0 0 5) ,与PVR呈显著正相关 (r=0 91 ,P <0 0 5)。结论 全腔静脉肺动脉连接术后 ,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。其术后短期内刺激ET 1分泌增加所引起的肺血管阻力升高 。

Objective: To study the effect of non pulsatile blood flow on the function of pulmonary endothelin 1 (EF 1) in patients undergoing total cavopulmonary connection (TCPC). [WT6HZ組ethods: [WT6BZ]32 patients with congenital heart diseases were studied, including 16 patients underwent TCPC and 16 patients underwent definitive repair for ventricular septal defect or atrial septal defect. Blood samples were obtained in the pre operative, post operative and followed up periods for measurement of ET 1. Cardiac index (CI) and pulmonary vascular resistance (PVR) were measured by cardiac catheter. Results: Plasma level of ET 1 was significantly higher in the early period and return normal in followed up period in TCPC group than that in control group. ET 1 had a positive correlation with PVR (P<0 05), and a negative correlation with CI (P<0.05). Conclusion: The non pulsatile blood flow in pulmonary circulation has some effects on the endocrine function of pulmonary endothelial cell, and the increase of ET 1 release in the early post operative period may be of clinical importance.