摘要目的 观察婴幼儿先天性心脏病心肺转流术(CPB)围手术期一氧化氮(NO)、内皮素(ET-1)和循环内皮细胞(CEC)水平的变化,初步探讨阿魏酸钠对血管内皮功能的保护作用.方法 60例先天性心脏病病儿随机分为阿魏酸钠组(S组)和对照组(C组)各30例.S组于体外循环前静脉滴注阿魏酸钠注射液8 mg/kg,C组予等量平衡盐溶液,检测CPB前(TO)、30 min(T1)、结束时(T2)、手术后2h(T3)、6 h(T4)5个时间点血浆NO和ET浓度,以及T0和T2两个时间点的CEC变化.结果 两组间T0比较差异不明显,12与T0比较CEC浓度均升高明显;T2时与C组比较,S组CEC升高幅度明显被抑制,差异有统计学意义(P<0.05).两组血浆N0浓度T1均降低,差异有统计学意义,组间比较无统计学意义(P>0.05),T2、T3、T4时间点两组NO浓度均有所上升,但均低于T0,差异明显,S组NO降低程度比C组小(P<0.05).两组T1时ET-1稍有降低,随后ET-1升高明显(P<0.01);S组T1、T2、T3、T4时间点均低于C组,差异有统计学意义(P<0.05或P<0.01).结论 体外循环手术可造成NO/ET失平衡状态,CEC数明显增加,证实CPB后存在着血管内皮功能的损伤.阿魏酸钠组术后NO下降幅度,ET、CEC升高的幅度,明显较对照组小,阿魏酸钠可有效拮抗ET的分泌,促进NO的生成,对婴幼儿体外循环手术有较好的血管内皮功能保护作用.

abstractsObjective Cardiopulmonary bypass (CPB) and its related ischemia reperfusion injury may cause endothelial cell injury.To study the protective effects of sodium ferulate in vascular endothelial function during CPB by testing the changes of vascular endothelial cell( CEC),nitric oxide( NO) and endothelin-1 ( ET-1 ) in children with congenital heart disease.Methods Sixty patients with congenital heart disease,including 28 males and 32 females were studied.The mean age was (19.7 ±10.4) months and body weight (10.5 ±6.1) kg.There were 37 VSD,8 ASD,7 TOF,5 TAPVC and 3 CAVC,among them 26 patients had pulmonary hypertension.They were randomly divided in to two groups:sodium ferulate group ( group S,n = 30),and control group ( group C,n =30) .Sodium ferulate (8 mg/kg) was given intravenously before CPB.Blood samples were taken from the arterial line at following time points:before CPB (TO),bypass 30 min(Tl ),the termination of CPB (T2 ),2h after operation ( T3 ) and 6h after operation ( T4 ),respectively for determination the concentration of vascular endothelial cell (CEC) in the blood,the concentration of nitric oxide (NO) and endothelin-1 ( ET-1) in the plasma.Results There were no significant difference for the two groups regarding above parameters at TO ( P > 0.05).The level of CEC was significantly elevated after CPB in both groups ( P < 0.05 ) .CEC were lower at T2 in group S than in group C ( P < 0.05 ) .NO was decreased in both groups,but was higher in group S at T2,T3 and T4 ( P < 0.05 ) .The concentration of plasma ET-1 was not significantly different before CPB,but there was a slight decrease at T1,and then it was significantly increased in both groups (P<0.05).But it was lower in group S than in group C at T1,T2,T3 and T4(P<0.05 orP<0.01).Conclusion There was severe endothelial cell damage during CPB.Sodium Ferulate can effectively antagonize the secretion of ET-1 to promote the formation of NO.Therefore,it reduces CPB-induced endothelial cell damage and protects vascular endothelial function during CPB.