卵圆孔单向活瓣术对室缺伴重度肺高压患者术后早期ET-1表达影响的研究
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摘要
目的:室缺肺高压患者行修补术,术中应用卵圆孔单向活瓣进行手术,探讨该手术方式对室缺肺高压患者术后早期ET-1的影响。方法 :将同期患先心病室间隔缺损患者,经行心脏彩超评估为中重度肺动脉高压患者18例,体外循环下行室间隔缺损修补手术,按术中是否采用卵圆孔单向活瓣手术,将患者分为单向活瓣组(n=11)和常规手术组(n=7),术前、术后2 h、4h、8 h、16 h、24 h、术后3 d应用酶免法进行血清ET-1检测。结果 :两组患者术前一般资料差异无统计学意义;单向活瓣手术组血清ET-1比较,术前与术后各组比较差异均具有统计学差异;常规手术组血清ET-1比较,术前与术后24 h、术后3 d比较差异具有统计学差异;单向活瓣组和常规手术组各时点血清ET-1比较差异无统计学意义。两组患者均有1例术后死亡。结论:室间隔缺损并肺高压患者行卵圆孔单向活瓣术,术后早期血清ET-1表达即明显降低,且较常规手术组改善早。该手术方法可能对缓解术后早期肺动脉高压危象发生有一定帮助。
Objective: To evaluate the effect of foramen ovale unidrectional valved pacth on the expression of ET-1 at the early stage post-surgery in VSD patients with severe PAH. Methods: Eighteen cases of VSD patients with the severe PAH assessed by echocardiography were divided into two groups, unidrectional valved pacth group(n = 11) and the conventional surgery group(n = 7). All cases were repaired under cardiopulmonary bypass.Serum ET-1 of all cases were analyzed prior to operation and at 2 h, 4 h, 8 h, 16 h, 24 h, and 3 d post-operation using enzyme immunoassay. Data were analysed using SPSS17.0 software, and P < 0.05 was considered statistically significant. Results: There were no significant differences between the two groups in terms of demographic information. There were significant differences of the levels of plasma ET-1 between pre-operation and postoperation at 2 h, 4 h, 8 h, 16 h, 24 h, and 3 d in the Unidrectional Valved Pacth group, and between pre-operation and postoperation at 24 h and 3 d in the conventional surgery group. There were no significant differences of the plasma ET-1 between the two groups. One patient was dead after operation in each group.Conclusion: Postoperative plasma ET-1 expression was markedly reduced in the unidrectional valved pacth group, and the reduction happened earlier than the conventional surgery group, indicating unidrectional valved pacth maybe good to reduce the occurrence of PAH crisis at the early stage post-operation.
Objective: To evaluate the effect of foramen ovale unidrectional valved pacth on the expression of ET-1 at the early stage post-surgery in VSD patients with severe PAH. Methods: Eighteen cases of VSD patients with the severe PAH assessed by echocardiography were divided into two groups, unidrectional valved pacth group(n = 11) and the conventional surgery group(n = 7). All cases were repaired under cardiopulmonary bypass.Serum ET-1 of all cases were analyzed prior to operation and at 2 h, 4 h, 8 h, 16 h, 24 h, and 3 d post-operation using enzyme immunoassay. Data were analysed using SPSS17.0 software, and P < 0.05 was considered statistically significant. Results: There were no significant differences between the two groups in terms of demographic information. There were significant differences of the levels of plasma ET-1 between pre-operation and postoperation at 2 h, 4 h, 8 h, 16 h, 24 h, and 3 d in the Unidrectional Valved Pacth group, and between pre-operation and postoperation at 24 h and 3 d in the conventional surgery group. There were no significant differences of the plasma ET-1 between the two groups. One patient was dead after operation in each group.Conclusion: Postoperative plasma ET-1 expression was markedly reduced in the unidrectional valved pacth group, and the reduction happened earlier than the conventional surgery group, indicating unidrectional valved pacth maybe good to reduce the occurrence of PAH crisis at the early stage post-operation.
引文
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8 .梁家立,张广福,李守先,等.同种带单向活瓣主动脉补片在先天性心脏病重度肺动脉高压病人中的应用[J].中华胸心血管外科杂志,2006,2(5):331.
9 .Jeffcry TK,Morre II NW.Molecular and cellular basis of pulmonary vascular remondeling in pulmonary hypertension[J].Prog Cardiovasc Dis,2002,45(3):173-202.
10 .N.Galie,M.M.Hoeper,M.Humbert,et al.Guidelines for the diagnosis and treatment of pulmonary hypertension[J].Eur Respir J,2009,(34):1219-1263.
11 .Yoshimune Hiramoto,Wataru Shioyama,et al.Clinical significance of plasma endothelin-1 level after bosentan administration in pulmonary arterial hypertension[J].Journal of Cardiology,2009,53(3):374-380.
12 .Ross B,D’Orléans-Juste P,Giaid A.Potential role of endothelin-1 in pulmonary fibrosis:From the bench to the clinic[J].Am J Respir Cell Mol Biol,2010,42:16-20.
13 .Dongmin Shao,John E.S.Park,Stephen J.The role of endothelin-1in the pathogenesis of pulmonary artery hypertension[J].Pharmacological Research,2011,63(6):504-511.
14 .A.M.Malek,J.Zhang,J.Jiang,et al.Izumo.Endothelin-1gene suppression by shear stress:pharmacological evaluation of the role of tyrosine kinase,intracellular calcium,cytoskeleton,and mechanosensitive channels[J].J Mol Cell Cardiol,1999,31:387-399.
2 .屈利平,龚业琼,吴晓莉,等.超声心动图在风湿性心脏病合并重度肺动脉高压瓣膜置换术中的应用[J].临床超声医学杂志,2011,13(10):711-712.
3 .Engelfriet PM,Duffels MG,M觟ller T,et al.Pulmonary arterial hypertension in adults born with a heart septal defect:the Euro Heart Survey on adult congenital heart disease[J].Heart.2007,93(6):682-687.
4 .J.R Runo,J.E Loyd.Primary pulmonary hypertension[J].Lancet,2003,361:1533-1544.
5 .Ad N,Birk E,Barak J,et al.A One-way valved atrial septal patch:a new surgical technique and its clinical application[J].J Thorac Cardiovasc Surg,1996,111(4):841-848.
6 .Swanson MJ,Fabaz Aq Jung JY.Successful treatment of right ventrieular failure with atrial septostomy[J].Chest,1987,92(5):950-952.
7 .Novick WM,Gurbuz AT,Watson DC,et al.Double patch closure of ventricular septal defect with increased pulmonary vascular resistance[J].Ann Thorac Surg,1998,66(55):1533-1538.
7 .庞昕焱,李卫华,宋惠民,等.单向活瓣补片在合并重度肺动脉高压的先天性心脏病患者手术治疗中的应用[J].中华医学杂志,2004,84(11):888-890.
8 .梁家立,张广福,李守先,等.同种带单向活瓣主动脉补片在先天性心脏病重度肺动脉高压病人中的应用[J].中华胸心血管外科杂志,2006,2(5):331.
9 .Jeffcry TK,Morre II NW.Molecular and cellular basis of pulmonary vascular remondeling in pulmonary hypertension[J].Prog Cardiovasc Dis,2002,45(3):173-202.
10 .N.Galie,M.M.Hoeper,M.Humbert,et al.Guidelines for the diagnosis and treatment of pulmonary hypertension[J].Eur Respir J,2009,(34):1219-1263.
11 .Yoshimune Hiramoto,Wataru Shioyama,et al.Clinical significance of plasma endothelin-1 level after bosentan administration in pulmonary arterial hypertension[J].Journal of Cardiology,2009,53(3):374-380.
12 .Ross B,D’Orléans-Juste P,Giaid A.Potential role of endothelin-1 in pulmonary fibrosis:From the bench to the clinic[J].Am J Respir Cell Mol Biol,2010,42:16-20.
13 .Dongmin Shao,John E.S.Park,Stephen J.The role of endothelin-1in the pathogenesis of pulmonary artery hypertension[J].Pharmacological Research,2011,63(6):504-511.
14 .A.M.Malek,J.Zhang,J.Jiang,et al.Izumo.Endothelin-1gene suppression by shear stress:pharmacological evaluation of the role of tyrosine kinase,intracellular calcium,cytoskeleton,and mechanosensitive channels[J].J Mol Cell Cardiol,1999,31:387-399.