体外循环中肾功能改变及其与TXA_2／PGI_2失衡关系的临床研究

Change of Renal Function during Cardiopulmonary Bypass and Its Relation to the Imbalance of TXA_2/PGI_2

应用α_１－微球蛋白（α_１－ＭＧ）及β_２－微球蛋白（β_２－ＭＧ）为肾损害指标，研究２０例行体外循环术患者术中肾功能改变及其与血浆血栓素Ａ_２－前列环素（ＴＸＡ_２／ＰＧＩ_２）失衡的关系。结果示：（１）血清α_１－ＭＧ及β_２－ＭＧ术中均升高；（２）尿α_１－ＭＧ及β_２－ＭＧ术中均升高，停机后１ｈ尿α_１－ＭＧ恢复至术前水平，尿β_２－ＭＧ术后６ｈ未恢复；（３）血浆肌酐、尿素氮均在正常范围；（４）相关分析表明停机时血清α_１－ＭＧ与术中ＴＸＡ_２／ＰＧＩ_２比值呈高度正相关（ｒ＝０．８３．Ｐ＜０．０１），血清β_２－ＭＧ与ＴＸＡ_２／ＰＧＩ_２呈高度正相关（ｒ＝０．７０，Ｐ＜０．０５）。作者认为：（１）体外循环中存在肾小球滤过率下降及肾小管损害；（２）体外循环中肾损害与术中ＴＸＡ_２－ＰＧＩ_２失衡有关。

Using α_1-MG and β_2-MG as the indicators of renal dysfunction,we studied the change of renal function during cardiopulmonary bypass(CPB)and its relation to the imbalance of TXA_2/PGI_2 in 20 patients undergoing open heart operations.The results showed that:(1)α_1-MG andβ_2-MG in serum and urine rose significantly during CPB;(2)α_1-MG in urine returned to normal in 1 hr after CPB while β_2-MG did not in 6 h after CPB;(3)BUN and Cr in plasma remained normal during CPB;(4)The ratio of TXB_2 to 6-Keto-PGF_1α was significantly correlated to the sera level of β_2-MG and α_1-MG. We concluded that renal dysfunction exists and is related to the imbalance of TXA_2/PGI_2 during CPB.