摘要
目的 本实验通过对血栓调节蛋白、血管性假血友病因子的观察 ,旨在了解体外循环 (CPB)对全身血管内皮的急性损伤 /活化 ,以及内皮素在该过程中的变化。方法 12例先天性心脏病心内畸形矫治术患者 ,房缺修补术 6例 ,室缺修补术 6例。采用异丙酚、咪唑安定、维库溴胺和芬太尼诱导 ,麻醉维持以吸入异氟醚和分次静脉注射维库溴胺、芬太尼、安定及氯胺酮等。CPB中非搏动灌注 ,灌注流量为 2 .0～ 2 .6L/ (min·m2 ) ,鼻咽温 3 2～ 3 3℃。于麻醉后CPB前、CPB3 0min、停CPB、停CPB后 1h、2 4h、72h、6个时点采集静脉血 ,动态观察患者血浆中血栓调节蛋白 (Thrombomodulin ,TM)、血管性假血友病因子 (vonWillebrandFactor,vWF)和内皮素 - 1在该过程中的变化。结果 TM、vWF在CPB3 0min时己显著升高 ,至停CPB时升至最高点 ( 6.3± 2 .1)ng/ml和 ( 2 42 .9± 84.0 ) % (p<0 .0 1) ,而后有下降趋势 ,但至停CPB后 72h仍未恢复到CPB前水平 ( p<0 .0 5或 p<0 .0 1)。ET - 1在整个过程中先下降后上升 ,停CPB后 1h( 72 .6± 16.9)ng/L与 72h( 99.8± 44 .5 )ng/L比较有显著性差异 ( p<0 .0 5 )。结论 CPB可导致血管内皮细胞的广泛损伤
OBJECTIVE Investigate vascular endothelial cell injurvation by measuring thrombonodulin(TM), vonWillerand(vWF) and endthelial(ET-1) during cardiopulmonary bypass.METHODS A prospective randomized study was performed on 12 patients with acyanotic congenital heart disease undergoing corrective surgical procedures. Six blood samples were taken at before CPB,30min following CPB, at the end of bypass, and after 1 h, 24 h, 72 h CPB, to measure the levels of thrombomodulin(TM), von Willebrand Factor (vWF)and endothelial-1(ET-1). RESULTS The levels of TM and vWF significantly elevated during CPB and raised up to the top immediately after discontinuing bypass, as compared with those before CPB(p<0.01),and have not returned to nomal 72h after the termination of CPB. The concentration of plasma ET-1 droped to the lowest level 1h CPB and increased gradulately to a peak level 72h after the termination of CPB(p<0.05). CONCLUSION The injury and activation of vascular Endothelial Cell were induced by CPB.
出处
《中国体外循环杂志》
2003年第2期75-77,共3页
Chinese Journal of Extracorporeal Circulation
