Xie Wen-xi, Yue Li-min, Song Hai-long
Department of Anesthesiology, The Second Affiliated Hospital & Yuying Children Hospital, Wenzhou Medical College, Zhejiang 325027.
Zhongguo Zhong Xi Yi Jie He Za Zhi. 2010 Mar;30(3):264-7.
To assess the condition of myocardial injury after cardiopulmonary bypass (CPB) and the effects of breviscapine (BVC) on cardiac function in children undergoing open heart surgery.
Thirty-six children (ASA II or III, aged 2-65 months) scheduled to receive ventricular septal defect repairing were randomly assigned to three groups, the control group treated with saline, and the BVC treated groups treated respectively with low dose (0.5 mg/kg) and high dose (1.0 mg/kg) BVC, 12 patients in each group. Saline or BVC (in volume of 15 mL) was administered intravenously after induction of anesthesia with micro-pump within 30 min. Blood levels of troponin I (cTn-I ) and malondialdehyde (MDA) were measured at different time points: pre-operation (T0), during aortic unclamping (T1), and 30 min, 1 h, 6 h, 24 h after aortic unclamping (T2, T3, T4, T5). And the time of operation, CPB, aortic unclamping, and the condition of drainage in 24 h after operation as well as the dosages of narcotics (midazolam, propofol and fentanyl) used were recorded.
No significant difference among groups was found in terms of sex ratio, age, body weight, time of aortic unclamping, CPB and operation, as well as the dosages of narcotics used and the volume of post-operation drainage. Compared with baseline (T0), levels of cTn-I at T1, T4 and T5 increased significantly in all three groups (P<0.01), with the peak revealed at T4; cTn-I in the control group were higher than those in the low dose BVC treated group at T1 and T4 (P<0.01), and those in the high dose BVC group at T1, T4, and T5, while it was insignificantly different between the two BVC treated groups. Level of plasmal MDA began to rise in all groups at T1 with the peak revealed at T2, it lowered after then, and reached the baseline at T5; comparison between groups showed that it was lower in the BVC treated groups than in the control group at T1-T4.
Different degree of cardiac injury always happens after open heart surgery and CPB, showing high level of cTn- I within 24 h with the peak revealed at 6 h after aortic unclamping. Intravenous perfusion BVC before CPB at the dose of 0.5 or 1 mg/kg could protect the cardiac function to some extent.
评估体外循环（CPB）后儿童心肌损伤情况以及灯盏花素（BVC）对接受心脏直视手术患儿心功能的影响。
36例计划行室间隔缺损修补术的儿童（美国麻醉医师协会分级II或III级，年龄2 - 65个月）被随机分为三组，对照组给予生理盐水，BVC治疗组分别给予低剂量（0.5 mg/kg）和高剂量（1.0 mg/kg）BVC，每组12例。麻醉诱导后30分钟内用微量泵静脉输注生理盐水或BVC（15 mL）。在不同时间点测量肌钙蛋白I（cTn-I）和丙二醛（MDA）的血药浓度：术前（T0）、主动脉开放时（T1）、主动脉开放后30分钟、1小时、6小时、24小时（T2、T3、T4、T5）。记录手术时间、CPB时间、主动脉开放时间、术后24小时引流量以及使用的麻醉药（咪达唑仑、丙泊酚和芬太尼）剂量。
三组在性别比例、年龄、体重、主动脉开放时间、CPB时间、手术时间、麻醉药使用剂量及术后引流量方面差异无统计学意义。与基线（T0）相比，三组在T1、T4和T5时cTn-I水平均显著升高（P<0.01），T4时达到峰值；对照组在T1和T4时的cTn-I水平高于低剂量BVC治疗组（P<0.01），在T1、T4和T5时高于高剂量BVC组，而两个BVC治疗组之间差异无统计学意义。血浆MDA水平在T1时开始升高，T2时达到峰值，随后下降，T5时恢复至基线；组间比较显示，在T1 - T4时，BVC治疗组低于对照组。
心脏直视手术和CPB后总会发生不同程度的心肌损伤，术后24小时内cTn-I水平升高，主动脉开放后6小时达到峰值。CPB前静脉灌注0.5或1 mg/kg剂量的BVC可在一定程度上保护心功能。
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