Department of Cardiovascular Surgery, Ankara Gazi Mustafa Kemal State Hospital, Ankara, Turkey.
Department of Cardiovascular Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Indian J Med Res. 2020 Dec;152(6):626-632. doi: 10.4103/ijmr.IJMR_2215_18.
BACKGROUND & OBJECTIVES: Oxidative stress can cause many diseases and increases the risk of post-operative complications in children with congenital heart disease. For these reasons, this study was aimed to investigate the differences between cyanotic and acyanotic paediatric patients who underwent heart surgery with markers of oxidative stress.
Eighty five patients were included in the study. The samples taken before the surgery and within the first 24 h after the surgery were evaluated for haemoglobin (Hb), leukocytes, uric acid, glutathione (GSH), malondialdehyde and total antioxidant capacity. Cyanotic, acyanotic, hyperoxygenated, normo-oxygenated, cardiac surgery with or without cardiopulmonary bypass (CPB) comparisons were made.
Positive correlation was found between age and pre-operative total antioxidant status values. Cyanotic and acyanotic patients did not have different antioxidant reserve capacities preoperatively. Although pre-operative thiobarbituric acid reactive substances (TBARS) levels were significantly lower in cyanotic patients, post-operative levels were higher. TBARS levels increased and GSH levels reduced postoperatively. The level of oxygenation did not cause a significant difference on markers of oxidative stress. The duration of CPB did not have negative effects on oxidative stress.
INTERPRETATION & CONCLUSIONS: Cyanotic and younger patients were found to be more vulnerable to oxidative stress. The increased levels of TBARS and the decreased levels of GSH could be the indicators of oxidative damage depending on many factors such as surgery, CPB, ischaemia/reperfusion, inflammation, iron overload and oxygenation. The level of oxygenation does not cause a noticeable difference in oxidative stress. CPB causes oxidative stress, but if it is conducted appropriately, the duration of CPB does not cause a significant negative impact on oxidative stress.
氧化应激可导致多种疾病，并增加先天性心脏病患儿术后并发症的风险。基于这些原因，本研究旨在探讨行心脏手术的紫绀型和非紫绀型儿科患者之间氧化应激标志物的差异。
本研究纳入了 85 例患者。评估了手术前和手术后 24 小时内的血红蛋白（Hb）、白细胞、尿酸、谷胱甘肽（GSH）、丙二醛和总抗氧化能力。比较了紫绀型、非紫绀型、高氧型、正常氧型、伴或不伴体外循环（CPB）的心脏手术。
年龄与术前总抗氧化状态值呈正相关。术前紫绀型和非紫绀型患者的抗氧化储备能力没有差异。虽然紫绀型患者术前的硫代巴比妥酸反应物质（TBARS）水平较低，但术后水平较高。术后 TBARS 水平升高，GSH 水平降低。氧合水平对氧化应激标志物没有显著影响。CPB 持续时间对氧化应激没有负面影响。
发现紫绀型和年龄较小的患者更容易受到氧化应激的影响。TBARS 水平升高和 GSH 水平降低可能是氧化损伤的指标，这取决于手术、CPB、缺血/再灌注、炎症、铁过载和氧合等多种因素。氧合水平对氧化应激没有明显影响。CPB 会引起氧化应激，但如果操作得当，CPB 持续时间不会对氧化应激产生显著的负面影响。
