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目的 :探讨小儿体外循环 (CPB)围术期血清细胞间粘附分子 1 (ICAM 1 )水平变化规律和升高原因及测定的临床意义。方法 :采用双抗夹心法酶联吸附试验 (ELISA)法分别于手术前、转流后 3 0min、手术毕、术后 2h、1 2h、2 4h、48h共 7个时点测定 3 3例先天性心脏病 (CHD)患儿 ;分别于术前 ,术中及术后 2h测定 1 0例非体外循环普胸手术患儿及 3 0例健康体检患儿ICAM 1水平。结果 :CHD术前ICAM 1无变化 ;CPB术后ICAM 1水平较非CPB明显升高 ,P <0 .0 0 5 ;血清ICAM 1值于CPB 3 0min后开始上升 ,至 2 4h达到高峰后开始下降 ,48h尚未降至术前水平 ;CPB时间≥ 90min组ICAM 1显著升高 ,P <0 .0 5。结论 :小儿CPB心脏直视手术后血清ICAM 1升高明显 ,CPB时间是ICAM 1升高的主要原因 ,ICAM 1测定对预防及早期发现并发症有一定的临床意义。
OBJECTIVE: To investigate the changes of serum ICAM-1 level and the reasons for the increase and the clinical significance in the perioperative period of pediatric cardiopulmonary bypass (CPB). Methods: Thirty-three cases of congenital heart failure were detected by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA) before operation, 30 minutes after operation, 2 hours after operation, 2 hours after operation, 12 hours after operation, Patients with CHD were enrolled in this study. ICAM-1 levels were measured in 10 children undergoing cardiopulmonary bypass and 30 healthy children undergoing preoperative, intraoperative and postoperative 2h respectively. Results: There was no change in ICAM 1 before CHD; the level of ICAM 1 in CPB was significantly higher than that in non-CPB (P <0.05); the value of serum ICAM 1 increased at 30 min after CPB and reached the peak at 24 h 48h had not dropped to preoperative level; ICAM 1 was significantly increased at CPB ≥ 90min, P <0.05. CONCLUSION: Serum ICAM-1 is significantly elevated after CPB surgery in children. CPB time is the main reason for the increase of ICAM-1. The ICAM-1 assay has some clinical significance for the prevention and early detection of complications.