体外循环与内皮素和降钙素基因相关肽的临床与实验研究

ClinicalandExperimentalStudyofETandCGRPinCPB

为探讨心脏灌流及体外循环（ＣＰＢ）心内直视手术期间的内皮素（ＥＴ）和降钙素基因相关肽（ＣＧＲＰ）的变化及其临床意义。用含有ＥＴ和ＥＴ＋ＣＧＲＰ的ＫＨ液分别对离体大鼠心脏进行灌流并观察冠脉流量、乳酸脱氢酶（ＬＤＨ）及脂质过氧化产物丙二醛（ＭＤＡ）含量。对ＣＰＢ心脏手术病人围术期测定ＥＴ和ＣＧＲＰ含量。结果：（１）大鼠心脏在ＥＴ灌流期间冠脉血流明显减少，ＭＤＡ生成和ＬＤＨ漏出显著升高；同时灌流ＣＧＲＰ则为相反结果。（２）ＣＰＢ心脏手术病人术前ＥＴ含量明显高于术中及术后（Ｐ＜０．０１）；心脏复苏后ＥＴ达到最低水平，进入ＩＣＵ后ＥＴ开始回升。（３）ＣＰＢ期间ＣＧＲＰ含量与术前比无差异，术后２４小时ＣＧＲＰ明显高于术前及术中（Ｐ＜０．０５）。结论为心脏停搏液中似无必要添加ＣＧＲＰ去拮抗ＥＴ，术后早期适量应用ＣＧＥＰ会有所裨益。

AimitostudythedynamicchangesandclinicalsignificanceofETandCGRPduringper-fusiunnftheisolatedratheartandduringupenheartsurgeryunderCPD.Method,osn30isolatedratheartsperfusedwithKHsolutioncontainingETandCGRP,thecoronaryflowandbloodcontentsofI.DHandMDAweredetermined.ThebloodcontentsofETandCGRPweremeasuredperioperativelyinI5patietnsundergoingopenheartoperationwithCPB.Results,1.DuringheartperfusionwithET,theflowrateofcuroanaryarterywassignificantlyreduced,theproductionofMDAandtheleakagerateof1.DHweresignificantlyelevated(p<0.05-0.01).But,whenperfusedwithCGRPatthesametime,nppnsiteresultswereobtained.2.lnpatientswithopenheartsurgery,rhepreoperativelevelofETwashigherthanthatduringandafteroperativeperiod(P<0.01).Aftertheheartconvalesced,theETlevelcamednwntothelowe.tvalue.WhenpatientsweresentbacktoICU,theETcontentwentupagain.3.DuringCPB,thelevelofCGRPwassignificantlyhigherthanpreoperativeandpre-CPBvalues(P<0.0.).Conclusion.CGRPcanles.entheeffectofETinreducingthecoronaryarteryflowrate.SoitmaybcvaluabletouseCGRPintheearlypostoperativeperiod.ThereisnoreasontoaddtheCGRPtotheSt.Thomassolution.