中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

儿童胸腔镜心脏手术中奥美拉唑对胃肠道的保护作用

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目的 探讨奥美拉唑在婴幼儿胸腔镜体外循环(CPB)心脏手术中对胃肠道的保护作用。 方法 将127例先天性心脏病患者(年龄3~12岁)随机分为3组,实验组A和实验组B:行胸腔镜微创手术治疗,对照组:行常规手术治疗;实验组A在CPB预充液中给予奥美拉唑10 mg,实验组B和对照组均注入等量生理盐水。3组均于术前、CPB 30min、CPB结束、术后4h、24h进行胃液常规检查,并采集血液标本,用ELISA法测定血清促胃液素。 结果 与CPB前比较:实验组A胃液pH值较CPB结束后有明显升高(Plt;0.01),实验组B于术毕有明显降低(Plt;0.05),对照组于术后4h较术前有明显降低(Plt;0.05); 3组胃液红细胞计数及血清促胃液素与CPB前比较均有明显上升(Plt;0.01)。与对照组比较:实验组A胃液pH于CPB 结束后各时间点较对照组有明显上升,而胃液红细胞计数则有明显下降,血清促胃液素于CPB 30 min时即较其它两组有明显降低。实验组B胃液pH于术毕有明显降低,但术后24h恢复至术前水平,同时间点胃液红细胞计数与促胃液素则有明显降低。 结论 儿童胸腔镜心脏手术中CPB时间较常规手术时间长,需要在此期间进行胃肠道保护,术后各项指标恢复较常规手术时间短

Objective To investigate the gastrointestinal(GI) protective effect of Omeprazole on children undergoing thoracoscopic heart surgery with cardiopulmonary bypass (CPB). Methods One hundred and twenty seven patients who were scheduled for cardiac surgery with CPB were randomly equally divided into three groups. Group A and B underwent thoracoscopic heart surgery, while the control group underwent conventional heart surgery by sternotomy. Before CPB, group A was treated with Omeprazole 10mg added to the priming solution.? Group B and the control group were treated by adding the same amount of normal saline (to the priming solution). pH and red blood cell count of gastric secretion and serum gastric level (Assay Designs ELISA) were measured at the following intervals: before CPB, 30 minutes into CPB, at termination of CPB,4 and 24 hours after termination of CPB. Results Compare to prior to CBP, the value of the gastric pH in group A was significantly higher (Plt;0.01), and that of group B was significantly lower (Plt;0.05)at the end of CPB. The same value in the control group was significantly lower (Plt;0.05)4h, after the end of CPB. Compared to prior CPB, the mean red blood cell count of gastric secretion and serum gastric level were significantly descent (Plt;0.01) in all there group post CBP. Compare to the control group, the mean gastric pH level in group A was significantly elevated at all time intervals post CBP; while the mean gastric secretin red blood cell count was significantly decreased. The mean serum level in group A 30 min post CBP was significantly lower than that in group B and the control group. Compared to the control group, the mean gastric pH level was significantly lower in group B but returned to the pre-CPB level in 24 h. The mean gastric secretin red blood cell amount and serums gastric level in group B at all time intervals were significantly decreased compare to those of the control group. Conclusion Thoracoscopic heart surgery of children with CPB

关键词: 胸腔镜; 奥美拉唑; 体外循环; 胃液酸碱度; 促胃液素; 胃肠道保护

Key words: Thoracoscope; Omeprazole; Cardiopulmonary Bypass; Cardiosurgery; Gastric juice pH; Gastrin; Gastrointestinal tract protection

引用本文: 魏旭峰,董小超,杨剑等. 儿童胸腔镜心脏手术中奥美拉唑对胃肠道的保护作用. 中国胸心血管外科临床杂志, 2007, 14(6): 429-. doi: 复制

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