CHILDREN UNDERGOING OPEN-HEART SURGERY

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。先天性心脏病影响全世界1%的儿童。许多心脏缺陷可以通过手术矫正，在美国每年大约有50万儿童接受心脏直视手术。与儿童心脏直视手术相关的发病和死亡的主要原因之一是全身性炎症反应综合征（SIRS）。该综合征导致体外循环（CPB）后终末器官功能障碍。在儿童中，肺特别容易受到cpb后功能障碍的影响，这可能表现为急性肺动脉高压危象和急性肺损伤。目前尚不清楚为什么有些儿童对CPB会产生夸张的炎症反应，而另一些则不会。也很难预测那些患儿术后会出现肺功能障碍。导致SIRS和cpb后儿童肺功能障碍差异的可能因素包括：遗传易感性、儿童原有的炎症状态和心脏病变类型。与无氰心脏病变相反，患有紫绀型心脏病变的儿童可能已经有继发于慢性缺氧的炎症反应上调。虽然有许多SIRS的标记物，但这些标记物都不能立即提供给临床医生，并且这些标记物与实际生物功能障碍之间的联系是不确定的。一个潜在的肺功能障碍的早期标志是呼出的一氧化氮。本研究的目的是检查接受CPB的儿童呼出的一氧化氮是否可以作为心脏麻醉师肺功能障碍的早期标志，并用于识别有风险的儿童，以潜在地预防进一步的肺损伤。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Congenital heart disease affects 1% of children worldwide. Many of these heart defects are amenable to surgical correction, with approximately 500,000 children undergoing open heart surgery every year in the USA. One of the major causes of morbidity and mortality associated with open heart surgery in children is the systemic inflammatory response syndrome (SIRS). This syndrome causes end-organ dysfunction following cardiopulmonary bypass (CPB). In children, the lungs are particularly vulnerable to post-CPB dysfunction and this may manifest as acute pulmonary hypertensive crisis and acute lung injury. It is unclear why some children will undergo an exaggerated inflammatory response to CPB and others do not. It is also difficult to predict those children that will develop post-operative pulmonary dysfunction. Possible factors contributing towards the differences in the SIRS and post-CPB lung dysfunction in children include: genetic predisposition, the pre-existing inflammatory state of the child, and the type of cardiac lesion. Children with cyanotic as opposed to acyanotic heart lesions may already have an inflammatory response that is upregulated secondary to chronic hypoxia. While there are numerous markers of the SIRS, none of these are immediately available to the clinician and the links between these markers and actual biological dysfunction are uncertain. One potential early marker of lung dysfunction is exhaled nitric oxide. The purpose of this study is to examine whether exhaled nitric oxide in children undergoing CPB could be an early marker of lung dysfunction for the cardiac anesthesiologist and be used to identify at risk children to potentially prevent further lung damage.