【摘要】 目的观察围术期体温调节在先天性心脏病患儿手术中对心肌肌酸激酶(CK)、CK同功酶(CK-MB)、心肌肌钙蛋白I(cTnI)的影响。方法3～7岁择期行先天性房、室间隔缺损修补手术的患儿40例,随机均分为观察组(Ⅰ组)和对照组(Ⅱ组)。Ⅰ组患儿入手术室后放置温度探头连续监测直肠温度和前额皮肤温度,调节室温在22～24℃,被褥保温,并采用变温毯维持直肠温度在37℃。皮肤消毒液温热至31～34℃,术中所有输注液体、血液均加热,在心肺转流(CPB)前、后维持直肠温度37℃至术后ICU4h。Ⅱ组患儿不采取特殊保温措施。分别于麻醉诱导前即刻(T0)、主动脉插管前即刻(T1)、CPB停止后即刻(T2)、术毕(T3)及术后2h(T4)抽取静脉血,测定CK、CK-MB、cTnI,并观察患儿苏醒情况、气管导管拔除时间。结果直肠温度在T1、T2时Ⅰ组明显高于Ⅱ组(P<0.05),皮肤温度在T2～T4时Ⅰ组明显高于Ⅱ组(P<0.05),两组CK、CK-MB、cTnI于T2～T4较T0时显著升高(P<0.05),同时Ⅱ组较Ⅰ组升高更为显著(P<0.05)。Ⅰ组患儿苏醒时间、气管导管拔除时间较Ⅱ组缩短(P<0.05)。结论先天性心脏病患儿手术中,在CPB前、后行体温调节,维持恒定体温37℃可减轻心肌损伤,对心肌有保护作用。更多还原

【Abstract】 Objective To study the body temperature regulation on myocardial creatine(CK),CK-isoenzyme(CK-MB) and troponin I(cTnI) in pediatric patients undergoing congenital heart disease(CHD) surgery.Methods Fourty children aged 3-7 years old with CHD undergoing heart surgery were randomized into two groups with 20 cases each.The rectal temperature in group I was kept at 37℃ by means of heat exchanger and fluids warming during operation.The patients in group II were treated conventionally without warming technique.CK,CK-MB and cTnI were measured at the time of pre-induction of anesthesia(T0),aorta catheterization(T1),discontinuation from CPB(T2),chest closure(T3) and 2 hours after surgery(T4),respectively.Perioperative rectal and skin temperatures and recovery data were recorded.Results CK,CK-MB and cTnI levels at T2-T4 were significantly increased compared with those at T0 in both groups(P<0.05),the increase of which in group Ⅰ was less than that in group Ⅱ(P<0.05).The recovery time of group Ⅰ was quicker than that of group Ⅱ.(P<0.05).Conclusion Maintenance of rectal temperature at 37℃ has a myocardial protective effect in pediatric patients undergoing CHD surgery.更多还原