体外循环中血浆ET-1、TXB_2及6-Keto-PGF_(1α)水平变化的探讨

Changes of Plasma ET-1,TXB_2 and 6-Keto-PGF_(1α) Levels in Patients Underwent Open Heart Surgery with Cardio-Pulmonary Bypass (CPB)

目的:探讨体外循环心内直视手术期间血浆内皮素-1(ET-1)、血栓素B2(TXB2)和6-酮-前列腺素F1α(6-Keto-PGF1α)水平变化及临床意义。方法:采用放射免疫分析分别于8个时点测定20例心内直视手术病人血浆ET-1、TXB2和6-Keto-PGF1α水平。结果:血浆ET-1水平从开放主动脉后即刻(T3)开始明显升高,至CPB停机后6h(T6)达高峰,之后逐渐下降,但仍明显高于手术前(T1)水平(P<0.01);TXB2水平在阻断主动脉即刻(T2)时逐渐升高,在T3时点达到最高峰,之后水平逐渐下降,至CPB停机后12h(T7)降至正常水平;血浆6-Keto-PGF1α水平从T2时点起急剧升高,T3时点时达最高峰,之后水平逐渐下降,至CPB停机后24h(T8)基本恢复至正常水平。结论:在CPB期间及CPB后动态监测病人血浆ET-1、TXB2及6-Keto-PGF1α可帮助综合判断病人情况,并可根据不同的激素代谢水平变化进行相应处理,如加入内皮素、血栓素A2拮抗剂或前列环素合成剂等,削弱缩血管效应,利于病人早期恢复。

Objective To study the clinical significance of the changes of plasme ET - 1, TXB2 and 6 - Keto - PGF1α levels in patients during and after cardio - pulmonary bypass （CPB）. Methods Plasma ET - 1, TXB2 and 6 - Keto - PGF1α levels were measured with RIA dynamically during CPB in 20 patients underwent open heart surgery. The measurements were done at： T1, after induction of aneasthesia, T2, start of CPB, T3, immediately after end of CPB, T4, 30min after and of CPB, T5, 2h after end of CPB, T6, 6h after, T7, 12h after, T8, 24h after. Results The plasma ET - 1 levels increased significantly immediately after the ending of CPB, reaching the peak concentration 6h after ending of CPB then decreased gradually but were still higher than the pre - op- erative level at 24h post CPB （P 〈 0.01 ）. The plasma TXB2 levels increased gradually after start of CPB, reaching the peak value at ending of CPB and then gradually decreased to pre - operative value at 12h post - CPB. The 6 - Keto - PGF1α levels also reached the peak value at the ending of CPB and lowered gradually to pre - operative value at 24h post - CPB. Conclusion Dynamic measure- ment of the plasma ET - 1, TXB2 and 6 - Keto - PGF1α levels during and within 24h after CPB might be helpful to assess the patients vasoactive and possibly eoagula - pathy condition. Corrective measures might be implemented ff warranted.