抑肽酶对冠脉阻力及其内皮细胞功能的影响

The Effect of Aprotinin on the Variety of Coronary Artery Resistance and the Function of Endothelial Cell during Heart Arrest with Warm Blood Cardioplegia

目的观察体外循环(extracorporeal circulation,ECC)瓣膜置换手术中抑肽酶和温血心肌灌注对心肌中内皮细胞(endothelial cell,EC)功能变化及其与冠状动脉阻力(coronary artery resistance,CAR)变化的关系的影响。方法随机选取风湿性心脏病(RHD)的二尖瓣置换(MVR)病例。A组(对照组):RHD瓣膜置换术,B组(实验组):RHD瓣膜置换术+抑肽酶,两组均为20例。所有患者于阻断开始、阻断30min、阻断60min、开放前温血灌注末留取静脉血标本,待分离循环系统内皮细胞(circulating endothelial cells,CEC),测定血小板颗粒膜蛋白(GMP-140)、6-酮-前列腺素F1α(6-K-F1α)、组织型纤活酶激活物(t-PA)。记录每次心肌灌注的压力及流量。结果ECC中各组CEC均升高,尤其是在阻断60 min时;A组CEC的变化显著高于B组。与EC分泌相关的因子在阻断60 min时有相应的升高,比较明显的是6-K-F1α(B组显著高于A组),并且其高峰滞后。B组在阻断60 min和末次温血灌注中冠脉阻力明显低于A组。结论在心脏停搏下手术时,EC功能与冠脉血管的张力调节密切相关,抑肽酶可以保护主动脉阻断温血灌注中EC的调节功能。

OBJECTIVE To observe the variations of the function of endothelial cell and coronary artery resistance （CAR） during heart arrest with warm blood cardioplegia with or without aprotinin. METHODS 40 patients suffered rheumatic heart disease were selected randomly. 20 of them were administered aprotinin during extracorporeal circulation （ECC） as group B （study group） ,others without apotinin as group A （control group）. The blood samples were taken at aortic clamping,30min,60min after aortic clamping,and end warm blood perfusion. The tissue -plasminogen activator （t - PA） ,the platelet granulate membrane protein 140 （GMP140） and the 6 - keto - PGF1α（ 6 - K -F1α） , circulating endothelial cell（CEC） were observed. The pressure and flux were recorded during warm blood cardioplegia. RESULTS ECC led CEC to increase,which peaked at 60min after aortic crossclamp. The EC related proteins increased at that time,but the peak of 6 -K -F1 in group A delayed than that in group B. CAR of group B was significantly lower than that of group B at 60 min after aortic crossclamp. CONCLUSION ECC leads to excessive activation, injury and dysfunction of EC ,while aprotinin can attenuate this process.