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目的探讨羟乙基淀粉130／0．4预充液对先天性心脏病患儿围体外循环期血管内皮细胞(VEC)及血管通透性的影响。方法择期体外循环(CPB)下行心内直视手术的先天性心脏病患儿40例,ASAⅡ或Ⅲ级,男19例,女21例,年龄5～18岁,随机分为2组(n=20):血浆组(对照组)和羟乙基淀粉130／0．4组(试验组)。对照组预充乳酸林格氏液和血浆,试验组预充乳酸林格氏液和羟乙基淀粉130／0．4。胶体预充液用量18-33 m1·kg-1,晶体:胶体=0．60-0．70。分别于转流前即刻(T1)、转流30min(T2)、转流结束即刻(T3)、转流结束6 h(T4)、术后第1天清晨(T5)检测血浆循环内皮细胞(CEC)数量、内毒素、可溶性细胞间粘附分子-1(sICAM-1)、肿瘤坏死因子-α(TNF-α)及尿微量白蛋白(U-Mal)浓度。结果．T1时两组CEC、内毒素、sICAM-1、TNF-α、U-Mal差异无统计学意义(P>0．05)。CEC:两组T2、T3及T4时较T1增高,T4时试验组低于对照组(P<0．05)。内毒素:两组T2、T3、T4时较T1升高,T3、T4、T5时试验组低于对照组(P<0．05)。sICAM-1:对照组T4、T5时较T1升高,T4时试验组低于对照组(P<0．05)。TNF-α:对照组T3时较T1升高,试验组低于对照组(P<0．05)。U-Mal:两组T4时较T1升高,试验组低于对照组(P<0．05)。结论羟乙基淀粉130／0．4预充液对先天性心脏病患儿围体外循环期VEC及其功能具有保护作用。
Objective To investigate the effect of hydroxyethyl starch 130 / 0.4 preconditioning on vascular endothelial cells (VEC) and vascular permeability during cardiopulmonary bypass in children with congenital heart disease. Methods 40 cases of congenital heart disease undergoing cardiopulmonary bypass (CPB) undergoing open heart surgery were ASA II or III, 19 males and 21 females, aged 5 to 18 years and were randomly divided into 2 groups (n = 20): plasma group (control group) and hydroxyethyl starch 130 / 0.4 group (experimental group). The control group was pre-filled with Ringer’s lactate solution and plasma. The experimental group was pre-filled with Ringer’s lactate solution and hydroxyethyl starch 130 / 0.4. The amount of colloidal prepreg 18-33 m1 · kg-1, crystal: colloidal = 0.60-0.70. The levels of circulating endothelial cells (CECs) were measured immediately before T1 (T1), 30min (T2), T3 (T3), 6h after the end of commutation (T4) ), Endotoxin, soluble intercellular adhesion molecule-1 (sICAM-1), tumor necrosis factor-α (TNF-α) and urinary microalbuminuria (U-Mal) result. There was no significant difference in CEC, endotoxin, sICAM-1, TNF-α and U-Mal between the two groups at T1 (P> 0.05). CEC: T2, T3 and T4 were higher than T1, T4 test group was lower than the control group (P <0.05). Endotoxin: The two groups were higher than T1 at T2, T3 and T4, but lower than the control group at T3, T4 and T5 (P <0.05). sICAM-1: The control group T4, T5 higher than T1, T4 test group was lower than the control group (P <0.05). TNF-α: The control group T3 was higher than T1, the experimental group was lower than the control group (P <0.05). U-Mal: T4 increased compared with T1, the experimental group was lower than the control group (P <0.05). Conclusion Hydroxyethyl starch 130 / 0.4 preconditioning has a protective effect on VEC and its function during cardiopulmonary bypass in children with congenital heart disease.