Analysis Of The Relationship Between Endogenous Hydrogen Sulfide,Nitric Oxide And Prognosis In Children With Congenital Heart Disease Complicated With Pulmonary Artery Hypertension

Objective:To investigate the changes of endogenous hydrogen sulfide and nitric oxide before and after operation in children with congenital heart disease complicated with pulmonary hypertension and their correlation with prognosis,so as to provide reference for postoperative monitoring?therapy and prognosis of children with PAH-CHD.Methods:Forty-eight healthy children who were examined in the physical examination center of our hospital from January 2019 to December 2019 were randomly selected as normal control group?group A?and 48 children with CHD admitted to cardiothoracic surgery in the same period as group B?group B?.According to the degree of PAH,the preoperative group was divided into three groups according to the degree of PAH:group B1?16 cases without PAH,pulmonary artery systolic pressure?30mm Hg?,group B2?mild PAH group 16 cases,pulmonary artery systolic pressure 31-45mm Hg?.Group B3?moderate to severe PAH group16 cases,pulmonary artery systolic pressure?46mm Hg?.In addition,32children with PAH-CHD who received CHD correction and were transferred to intensive care unit?ICU?after CHD were divided into two groups according to the presence or absence of PAH.Group C?postoperative PAH16,pulmonary artery systolic pressure>30mm Hg?,D group,no postoperative PAH16,pulmonary artery systolic pressure?30mm Hg).The concentrations of endogenous H₂S and NO in control group,preoperative group and postoperative group were measured by spectrophotometry.The severity of congenital heart disease,cardiopulmonary bypass time,aortic clamping time,mechanical ventilation time,ICU stay time,hospital stay and maximum vasoactive drug index?VIS-max?at 24 and 48 hours after CHD were recorded.The correlations between the contents of endogenous H₂S and NO at 24 and 48 hours after operation and the time of mechanical ventilation,the stay time of ICU,the time of hospitalization and the maximum vasoactive drug index at 24 and48 hours after operation were analyzed.Results:1. The concentrations of endogenous H₂S and NO in the control group were significantly higher than those in the preoperative group?P<0.05?.2. There were significant differences in endogenous H₂S and NO inthe groups without PAH,mild PAH and moderate to severe PAH before CHD,and were negatively correlated with the degree of pulmonary artery pressure.3. Spearman rank correlation analysis showed that the concentrationof endogenous H₂S at 24 hours and 48 hours after operation in group C was negatively correlated with mechanical ventilation time?r=-0.698,P<0.05;r=-0.715,P<0.05?,ICU stay time?r=-0.500,P<0.05;r=-0.576,P<0.05?,VIS-24max and VIS-48max?r=-0.621,-0.686,P<0.05;r=-0.578,-0.501,P<0.05?,but there was no significant correlation with hospitalization time?P>0.05?.The concentration of endogenous H₂S in group D was negatively correlated with the time of mechanical ventilation?r=-0.761,P<0.05;r=-0.555,P<0.05?,ICU stay time?r=-0.542,P<0.05;r=-0.615,P<0.05?,VIS-24max and VIS-48max?r=-0.572,-0.554,P<0.05;r=-0.663,-0.549,P<0.05?,but there was no significant correlation with hospitalization time?P>0.05?.4. The concentration of 48h NO at 24 hours in group C after operation was negatively correlated with VIS-24max and VIS-48max?r=-0.560,-0.508,P<0.05;r=-0.527,-0.615,P<0.05?,and the concentration of 48h NO was negatively correlated with VIS-24max and VIS-48max in group D?r=-0.516,-0.526,P<0.05;r=-0.552,-0.501,P<0.05?.However,there was no significant correlation between NO concentration and mechanical ventilation time,ICU stay time and hospitalization time in group C and D?P>0.05?.Conclusion:Both endogenous H₂S and NO play an important role in the formation of CHD with PAH.There is a certain correlation between endogenous H₂S and the prognosis of children after CHD.The higher the concentration of H₂S is,the better the prognosis may be,which can be used as one of the indexes to judge the prognosis in the early stage.