Research of reoxygenation injury in cardiopulmonary bypass of cyanotic congenital heart disease / 中华胸心血管外科杂志

ABSTRACT

Objective To investigate the effect and safety of different PaO2 to the reoxygenation injury of cyanotic congenital heart disease through controlling the FiO2 when initiating cardiopulmonary bypass (CPB).Methods Thirty patients with cyanotic congenital heart disease were divided into 3 equal groups according the PaO2 when initiating cardiopulmonary bypass:group 1 (G1,PaO2 ＜ 120 mm Hg) ; group 2 (G2,PaO2 120-180 mm Hg),group 3 (G3,PaO2 180-250 mm Hg),and ten patients with acyanotic congenital heart disease were group 4 (G4,PaO2 ＞ 200 mm Hg).Serum CK-MB,cTnI,IL-6,TNF-α,SOD,8-ISO and S100β were measured before CPB、5 minute after CPB,10 minute after CPB,5 minute after cross clamp releasing,2 hours and 24 hours post operation with intemal jugular vein blood samples.Clinical results were also recorded.Results CK-MB,cTnI,IL-6,TNF-α,8-ISO and S100β3 were all normal without significant differences between them before CPB.After initiation of CPB,their levels in all groups increased,reached the peak before or after the stop of CPB,then gradually declined.At each time point,the levels of these indexes were G3 ＞ G2 ＞ G1 ＞ G4 with significant difference between them (P ＜ 0.05) ; The serum SOD levels of G4 were higher than the other three groups with significant difference(P ＜ 0.05).They all declined after initiation of CPB,reached lowest after cross clamp releasing,then gradually increased.At 5 minute after CPB,10 minute after CPB,5 minute after cross clamp releasing,2 hours post operation,there were significant differences between four groups (P ＜ 0.05),and at 24 hours post operation,the SOD levels of G4 were higher than the other three groups with significant difference (P ＜ 0.05).There were no significant difference between G1,G2 and G3 in SvO2,Lac,positive vasoactive drugs、ventilation time and ICU time.All patients were alive.Conclusion Low reoxygenation concentration can reduce the reoxygenation injury of cyanotic congenital heart disease,though there may be some potential influence to cerebral oxygen metabolism.Further studies about oxygen supplymethodsare necessary in deep hypothermia and long-time CPB.