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目的观察心内直视手术患儿体外循环(cardiopulmonary bypass,CPB)术后心肌损伤情况,并评价灯盏花素是否具有心功能保护作用。方法择期行室间隔缺损修补术的学龄前患儿(≤6岁)36例,随机分成对照组(生理盐水)、低剂量灯盏花素组(低剂量组,0.5 mg/kg灯盏花素)和高剂量灯盏花素组(高剂量组,1 mg/kg灯盏花素)3组,每组各12例。于麻醉诱导完成后开始微泵静脉输注15 mL生理盐水或灯盏花注射液,30 min内输注完毕。分别于术前(T0)、主动脉阻断开放即刻(T1)、开放30 min(T2)、1 h(T3)、术后6h(T4)及术后24 h(T5)测定血浆肌钙蛋白-I(cTn-I)及丙二醛(MDA)浓度。同时记录手术时间、CPB时间、主动脉阻断时间以及术后24 h引流情况。记录所有患儿术中使用的咪达唑仑、异丙酚和芬太尼总量。结果3组患儿主动脉阻断时间、CPB时间、手术时间和术中咪达唑仑、异丙酚和芬太尼总量以及术后引流量比较差异均无统计学意义。与基础值(T0点)比较,3组患儿cTn-I于主动脉阻断开放后即刻、6 h及24 h(T1、T4、T5点)明显升高(P<0.01),峰值出现于主动脉阻断开放后6 h(T4点)。与对照组比较,低剂量组cTn-I值在T1、T4时间点较低(P<0.01),高剂量组在T1、T4、T5时间点较低(P<0.01),两剂量组间差异无统计学意义。3组患儿血浆MDA浓度在T1时点开始升高,并在主动脉开放后30 min(T2点)出现峰值,之后开始下降,并在T5时间点降至术前水平;与对照组比较,低、高剂量组于T1、T2、T3、T4时点浓度较低(P<0.01)。结论心内直视手术患儿体外循环后均发生不同程度的心肌功能损害,在主动脉阻断开放后24 h内cTn-I的高峰值出现于主动脉阻断开放后6 h。灯盏花素治疗组血浆cTn-I及MDA浓度较低,表明体外循环前静脉输注灯盏花素对体外循环心内直视手术所致心肌损伤具有一定的保护作用。
Objective To observe the myocardial injury after cardiopulmonary bypass (CPB) in children undergoing open heart surgery and to evaluate whether breviscapin has the function of cardiac function protection. Methods Thirty-six preschool children (≤6 years old) undergoing ventricular septal defect repair were randomly divided into control group (saline), low dose breviscapine group (low dose group, 0.5 mg / kg breviscapine) High-dose breviscapine group (high-dose group, 1 mg / kg breviscapine) 3 groups, 12 cases in each group. After induction of anesthesia began to micro-pump intravenous infusion of 15 mL saline or Erigeron Injection, 30 min infusion is completed. The plasma levels of troponin were measured before operation (T0), immediately after the aorta was opened and closed (T1), 30 min (T2), 1 h (T3), 6 h (T4) and 24 h -I (cTn-I) and malondialdehyde (MDA) concentrations. At the same time, the operation time, CPB time, the aorta occlusion time and the 24 h drainage were recorded. The total amount of midazolam, propofol and fentanyl used in all patients was recorded. Results There was no significant difference in aortic cross-clamping time, CPB time, operation time, intraoperative midazolam, total propofol and fentanyl volume and postoperative drainage among the three groups. Compared with the baseline (T0), cTn-I in 3 groups was significantly increased (P <0.01) at 6 h and 24 h (P <0.01) immediately after the aorta was opened and the peak appeared in Aortic occlusion 6 h after opening (T4 point). Compared with the control group, the cTn-I level in the low-dose group was lower at T1 and T4 (P <0.01), the high-dose group was lower at T1, T4 and T5 (P <0.01) No statistical significance. The plasma MDA levels of the three groups began to increase at T1 and peaked at 30 min (T2) after aortic opening, then began to decline and dropped to the preoperative level at T5. Compared with the control group, Low, high dose group at T1, T2, T3, T4 point concentration was lower (P <0.01). Conclusions Myocardial dysfunction occurs in children with cardiopulmonary bypass after cardiopulmonary bypass, and the peak of cTn-I appears within 6 hours after the aorta is opened and closed within 6 hours after the aorta is opened and closed. Breviscapine treatment group plasma cTn-I and MDA concentrations lower, indicating that pre-cardiopulmonary bypass infusion of breviscapine on cardiopulmonary bypass cardiopulmonary bypass surgery due to myocardial injury has a protective effect.