血浆内皮素-1水平在先天性心脏病体外循环围手术期的动态变化及临床意义

THE DYNAMIC CHANGE OF PLASMA ENDOTHELIN 1 DURING THE PERIOPERATIVE PERIOD IN PATIENTS WITH CONGENITAL HEART DISEASE AND ITS CLINICAL SIGNIFICANCE

目的观察血浆内皮素－１水平在先天性心脏病体外循环围手术期的动态变化。方法对２０例先天性心脏病在体外循环围手术期内皮素（ＥＴ－１），血栓素Ａ２（ＴＸＡ２），前列环素（ＰＧＩ２）进行动态监测。结果①患者术前动脉血ＥＴ－１水平高于静脉血ＥＴ－１水平，但差异不显著（Ｐ＞０．０５），术后２周动脉血ＥＴ－１水平低于静脉血ＥＴ－１水平，且差异显著（Ｐ＜０．０５）。②血浆ＥＴ－１水平在体外循环（ＣＰＢ）期间持续上升，并在ＣＰＢ结束时达到峰值，峰值与ＣＰＢ持续时间和ＣＰＢ结束时血浆ＴＸＡ２而与体外循环期间尿量呈负相关。③在整个围术期和ＣＰＢ期间，血浆ＥＴ－１水平均与血浆ＴＸＡ２水平呈正相关。结论①肺循环异常时，肺脏对ＥＴ的清除能力下降，动、静脉ＥＴ－１水平的差值可作为先天性心脏病体外循环术后肺循环改善的一项指标。②显著增高的ＥＴ－１可能与长时间ＣＰＢ后的心肾功能障碍有关。

Objective To observe the dynamic change of plasma endothelin 1 during the perioperative period in patients with congenital heart disease.Methord The blood samples were taken for determination of endothelin 1.(ET 1) thromboxane A 2(TXA 2) Prostacylin (PGI 2) pre ,intra and postoperatively.Result Before the operation,the venous ET 1 level was a little lower than the arterial level,but the differences did not reach statistical significance. After the operation,the arterial ET 1 level gradually began to decline to a lower level than the venous ET 1 level,but the differences between the arterial ET level and the venous ET 1 level did not reach statistical significance until two weeks after the operation. The plasma ET 1 concentration was also significantly increased during the course of cardiopulmonary bypass(CPB)and peaked at the end of CPB. The maximal ET 1 level correlated positively with the duration of CPB and the plasma TXA 2 concentration at the end of CPB, but negatively with the urine volume during CPB. The plasma ET 1 concentration correlated positively with the plasma TXA 2 concentration both during the perioperative period and during the CPB.Conculsion (1)When pulmonary hemodynamics is abnormal,the pulmonary ability to eliminate ET declines. The differences between the arterial ET 1 level and venous ET 1 level might be considered an indicator for the improvement of pulmonary hemodynamics in congenital heart disease after operation.(2)The markedly elevated plasma ET 1 can possibly be associated with cardiac or renal dysfunction after prolonged CPB.(3)TXA2 might play an important role in the dynamic change of plasma ET 1 levels.