| Objective: Nitrogen monoxide is a kind of signal convection molecul distributed in vivo widely,with many biological effects.The realm for involving is very extensive,it includes blood vessel adjustment, relax bronchi, nerve medium, body defense, inhibition of thrombocyte, cytotoxicity and so on, which increasingly cause the extorsive interest of people. In recent years , great evidence showed that NO played an important role in pneumoangiogram function and lung diseases. With regard to congenital heart disease patients, especially merging pulmonary hypertension patients, the investigation of lung lesion brings important significance. Now, it is clear that many cells can synthesis NO ,for example, angio- endothelial cells, thrombocyte, nerve cells, neutrophilic granulocyte, suprarenal gland cells, airway epithelial cells and so on.NO is a kind of gaseous free radicel with simple structure, extreme unsteady,latent toxicity, free diffusion to cell membrane. Its half life is very short, only 3~5 seconds, when it enters bronchioles and pulmonary alveolus with higher degree of humidity, 80 percent can stay in lung and react with respiratory tract moist producing NO2-and NO3-, part of them is inhaled into blood forming nitrate salt and nitrite salt.So, NO2-/NO3- is a well marker guideline to reflect NO synthesis.Blood serum or urine is taken as a sample on estimate of NO2-/NO3- in the investigation known to lung lesion of congenital heart disease patients , which is affected inevitably by NO that is produced by other locus of body, moreover ,the small part of NO2-/NO3- coming form pneumoangiogram isn't reflected sufficiently the true level of pulmonary local NO content. In this investigation, NO2-/NO3- content in sputum, made up of by which is purduced from pneumoangiogram endothelial cell and diffused to alveolar bronchiole(part of it inhaled in blood and expired out of body) and airway epithelial cells,more accurately reflects NO content level of constitution. This topic aiming at the NO2-/NO3- estimate in sputum of preoperative and the change of NO2-/NO3- in the CPB and therapy by inhaled in ectogenesis NO on congenital heart disease patients(divided by merging with pulmonary hypertension and unmerging with pulmonary hypertension ), discussed the change of NO metabolism level and the effects to pneumoangiogram, lung small airway in CPB and ectogenesis NO inhalation.Methods: Research object: 1. Congenital heart disease merging with pulmonary hypertension group( A group):22 samples, 13 males,9 females,age from six months to 14 years old;body weight(BW) from 5.5kg to31 kg, average 11.9kg: among of them 16 samples were ventricular septal defect,one sample was Patent Ductus Arteriosus,5 samples were compound teratosis. Selecting standard : the patients who have been diagnosed secondary or serious pulmonary hypertension (average pulmonary artery pressure 61mmHg) by heart ultrasound, cardiac catheterization and clinical Physical sign. 10 patients who were draw randomly in A group (A1 group)and treated by continusly inhalation of NO,another 12 patients were treated by transfusing sodium nitroprusside continuously in vein(A2 group)2.Congenital heart disease unmerging with pulmonary hypertension group (B group),14 samples, 9 males,5 females,age from 2 to 11 years old; body weight from 10.5 kg to 29 kg, average 13kg: among of them 1 sample was unilateral anomalous pulmonary venous connection, 8 samples were artrial septal defect, 5 samples were ventricular spetal defect. 3. control group(C group)10 samples, 7 males, 5 females, average age 3 years old; body weight from 10.5 kg to 29 kg, average body weight 16kgï¼›the patients were cheiloschisis, palatoschisis children. Above them excepted heart function failure,hypertension, renal function failure, primary pulmonary hypertension or cardiogenic shock deseases ,etc,And never used nitroglycerin categories special drugs. Anesthesia and extracorporeal circulation: After anesthesia induction the maintenance of tracheal cannula, mechanical ventila... |
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