摘要
目的探讨先天性心脏病(CHD)合并肺动脉高压(PH)患儿手术前后硫化氢(H2S)及血红蛋白氧合酶-1(HO-1)的变化及其临床意义。方法选取河北医科大学第四医院心脏外科收治的48例左向右分流的CHD患儿,均在复合麻醉中成功实施了根治手术。48例患儿行心脏多普勒术前测压,按照肺动脉收缩压高低(PASP)分为3组:无PH组(PASP<3.990kPa)15例,轻度PH组(PASP3.990～6.517kPa)15例,中重度PH组(PASP≥6.650kPa)18例。于术前、术后1h及术后24h采集各组患儿桡动脉血标本,用吸光度法测定血浆H2S水平,用双波长分光光度法测定血清HO-1活性。数据分析采用重复测量数据的方差分析、多因素方差分析、直线相关分析。结果各组患儿术后H2S水平呈上升趋势,术后24h与术前比较差异均有统计学意义(Pa<0.05)。术前、术后1h及术后24h,中重度PH组、轻度PH组血浆H2S水平均显著低于无PH组(Pa<0.05),中重度PH组血浆H2S水平均显著低于轻度PH组(Pa<0.05);术前、术后1h、术后24h,3组患儿血清HO-1活性比较差异无统计学意义;3组患儿血清HO-1活性组间比较差异无统计学意义。术前、术后1h及术后24h,H2S水平与PASP均呈负相关(Pa<0.01)。术前、术后1h及术后24h,HO-1活性与PASP均无相关性(Pa>0.05)。结论H2S在PH形成和肺血管重建中发挥重要作用。HO-1与PASP无相关性,但不能排除HO-1在PH形成和肺血管重建中有重要作用。血浆HS可作为判断PH严重程度的指标之一。
Objective To explore the clinical significance of hydrogen sulfide（H2S）and heme oxygenase-1（HO-1）on pulmonary hypertension（PH）,by detecting their levels of patients with congenital heart disease（CHD）.Methods Forty-eight patients with CHD who had left-to-right shunt were selected randomly from cardiac surgery in the Fourth Hospital of Hebei Medical University.Forty-eight patients were performed successfully on radical operation under complex intravenous anesthesia,and they were divided 3 groups according to pulmonary artery systolic pressure（PASP）detected by doppler echocardiography before operation：no PH group（PASP〈3.990 kPa,n=15）,mild PH group（PASP 3.990-6.517 kPa,n=15）,mid-heavy PH group（PASP≥6.650 kPa,n=18）.The radial artery blood specimens were collected immediately before operation,1 hour and 24 hours after operation.H2S in plasma was measured by optical absorbance method at 670 nm at each period.HO-1 activity in serum was measured by dual wavelength spectrophotometer at each period.The data were analyzed by repeated measures,multivariate ANOVA,and analysis of linear correlation.Results Plasma level of H2S of each group after ope-ration were higher than that of the same group before operation.Significant difference of the plasma level of H2S was found between 24 hours post-operation and pre-operation in the same group（Pa〈0.05）.Whatever pre-operation,1 hour post-operation or 24 hours post-operation,the plasma level of H2S in the mid-heavy PH group and mild PH group were significantly lower than that in no PH group（Pa〈0.05）,the plasma level of H2S in the mid-heavy PH group was significantly lower than that in mild PH group（Pa〈0.05）.The HO-1 activity in serum of each group after operation was no obvious difference on statistics compared with that before operation;the HO-1 activity in serum was no obvious difference on statistics among the 3 group.There were negative correlation between PASP and the plasma levels of H2S of the 3 groups at pre-operation,1 ho
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2010年第6期430-432,共3页
Journal of Applied Clinical Pediatrics
基金
河北省科技厅科技支撑计划项目(0727611001)
