快通道麻醉对先天性心脏病手术患儿外周血炎症因子及微小核糖核酸-1的影响

摘要

目的:探讨快通道麻醉对先天性心脏病手术患儿炎症因子及外周血微小核糖核酸(miRNA)-1的影响.方法:选取2015年1月至2016年12月在钦州市第二人民医院行先天性心脏病外科手术的120例患儿作为研究对象,按照随机数字表法将患儿分为对照组和快通道组,每组60例.对照组给予常规麻醉,快通道组给予快通道麻醉;观察并比较两组患儿手术情况、于动脉阻断前(T0)、动脉开放后15 min(T1)、30 min(T2)、60 min (T3)、180min(T4)炎症因子[肿瘤坏死因子(TNF)-α、白介素(IL)-6、C反应蛋白(CRP)]和外周血miRNA-1水平变化,并分析炎症因子与miRNA-1的相关性.结果:快通道组患儿术后拔管时间及CICU时间短于对照组(P＜0.05);与T0时间点相比较,两组患儿外周血炎症因子和miRNA-1水平在T1～T4时间点均显著升高(均P＜0.05),但快通道组在T1～T4时间点以上指标水平均明显低于对照组(均P＜0.05);两组患儿的TNF-α、IL-6、CRP与miRNA-1水平呈显著正相关关系(r=0.643、0.513、0.717,均P＜0.05).结论:采用快通道麻醉可显著降低先天性心脏病手术患儿外周血炎症因子及miRNA-1的水平,更有利于患儿术后恢复;miRNA-1或可作为心脏手术后的一种评估心肌炎症反应程度的检测指标.%Objective:To investigate the effects of fast-track anesthesia (FTA) on inflammatory factors and miRNA-1 in peripheral blood in children with congenital heart disease undergoing cardiac surgery.Methods:A total of 120 children with congenital heart disease who undergoing cardiac surgery in our hospital from January 2015 to December 2016 were recruited and randomly divided into control group and FTA group,with 60 cases in each group.The children in the control group received general anesthesia,and those in the FTA group received FTA.The levels of tumor necrosis factor (TNF)-α,interleukin (IL)-6,C-reactive protein (CRP) and miRNA-1 in peripheral blood were measured before aortic cross-clamping (T0),15 min after cross clamping remission (CCR) (T1),30 min after CCR (T2),60 min after CCR (T3),and 180 min after CCR (T4).The relationship between the inflammatory factors and miRNA-1 was analyzed by Pearson correlation analysis.Results:Postoperative extubation time and CICU hospital days in FTA group were shorter than those in the control group (P＜ 0.05).Compared with T0,the levels of TNF-α,IL-6,CRP and miRNA-1 at T1 to T4 were increased in both groups,and the increase was more significant in FTA group (P＞ 0.05).The levels of TNF-α,IL-6 and CRP were positively correlated with miRNA-1 level (r=0.643,0.517,0.747;P＜0.05).Conclusion:FTA application in cardiac surgery could effectively reduce inflammatory factors and miRNA-1 levels in children with congenital heart disease.miRNA-1 might be used as a reliable marker for evaluating inflammatory degree after cardiac surgery.