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目的:探讨循环血管紧张素Ⅱ(AngⅡ)是否加重先天性心脏病体外循环手术中心脏的缺血再灌注损伤。方法:从1999年10月26日至2000年1月25日接受体外循环手术的先心病患儿46例,年龄6～166个月,平均(52.79±20.56)个月,体重6～42千克,平均(19.23±10.00)千克。分别测定术中主动脉开放时血AngⅡ和四个心脏缺血再灌注损伤观察指标:(1)超声心动图估测术后心脏射血分数(EF);(2)术后24h内正性肌力药物的使用情况;(3)主动脉开放后6h血清肌酸激酶同工酶(CK-MB)浓度;(4)术后24h内严重心律失常的发生情况,比较两方面的关系。结果:术后正性肌力药物使用组和未用药组,严重心律失常发生组和未发生组的AngⅡ有显著性差异。AngⅡ与主动脉开放后6h血CK-MB显著相关。术后EF<0.5和≥0.5患者AngⅡ无显著性差异。结论:循环AngⅡ加重了先天性心脏病体外循环手术中心脏的缺血再灌注损伤。
Objective: To investigate whether circulating angiotensin Ⅱ (Ang II) aggravates the ischemia-reperfusion injury in the heart of extracorporeal circulation surgery of congenital heart disease. Methods: From October 26, 1999 to January 25, 2000, 46 children with congenital heart disease undergoing cardiopulmonary bypass were aged 6 to 166 months with an average of (52.79 ± 20.56) months and weight of 6 to 42 kg. Average (19.23 ± 10.00) kg. The indexes of angiotensin Ⅱ (AngⅡ) and ischemia-reperfusion injury in the four hearts during operation were measured respectively: (1) echocardiography was used to evaluate the postoperative ejection fraction (EF); (2) (3) Serum creatine kinase (CK-MB) concentration at 6h after aortic opening; (4) The incidence of severe arrhythmia within 24 hours after surgery, comparing the two aspects. Results: There was a significant difference in AngⅡ between the patients with and without medication of inosotics and the patients with severe arrhythmia. Ang ¢ ò was significantly associated with CK-MB at 6 h after aortic opening. Postoperative EF <0.5 and ≥ 0.5 patients Ang Ⅱ no significant difference. Conclusion: Circulating AngⅡ aggravates the ischemia-reperfusion injury of the heart in extracorporeal circulation surgery of congenital heart disease.