高危心脏病患者血浆ET、NPY、CGRP含量变化以及乌拉地尔对其的影响

The effect of urapidil on the plasma level of endothelin, neuropeptide Y and calcitonin gene-related pepitide in high-risk cardiac patients undergoing emergency noncardiac surgery

目的 观察乌拉地尔 (URA)对高危心脏病人 (HRC)患者围术期血浆内皮素 (ET)、降钙素基因相关肽 (CGRP)、神经肽Y(NPY)含量的影响。方法 用放射免疫分析方法测定 2 0例HRC患者血浆ET、NPY、CGRP水平 ,并以 4 0例健康者作对照 ;观察HRC患者经URA (0 4mg kg-1)静脉注射后诸指标变化。结果 HRC患者血浆ET明显高于正常对照组 (P <0 0 1) ;NPY显著高于正常对照组 (P <0 0 1) ;CGRP水平显著低于正常对照组 (P <0 0 1)。经URA治疗后HRC患者ET、NPY水平明显下降 (P <0 0 1) ,CGRP水平明显升高 (P <0 0 1)。HRC患者URA治疗前后血浆ET与CGRP水平间呈显著正相关 (r =0 5 82 1P <0 0 1;r =0 6 19P <0 0 1)。结论 ET、CGRP、NPY是参与HRC发病的重要体液因素 ,URA可明显提高HRC患者体内CGRP水平 ,有效拮抗ET、NPY的缩血管作用 。

Objective To investigate the usefulness of urapidil in the management of high risk cardiac patients undergoing emergency noncardiac operation Methods 20 cardiac patients (male 11, female 9) scheduled for emergency noncardiac surgery were included in this study The age averaged (54 1±16 5) years The heart diseases included pregnancy induced hypertension(PIH) complicated with congestive heart failure(CHF) in 5 patients, coronary artery heart disease in 7, hypertensive heart disease in 4 and rheumatic heart disease in 4 Functionally they were classed as Ⅱ or Ⅲ according to New York Heart Association(NYHA) classification 40 healthy blood donors served as normal control In operating room before anesthesia the patients were given an intravenous bolus of urapidil 0 4 mg kg -1 Venous blood samples were taken before and 15 min after intravenous administration of urapidil for determination of plasma concentration of endothelin (ET) neuropeptide Y (NPY) and calcitonin gene related pepitide (CGRP) by radioimmunoassay Results Plasma concentrations of ET and NPY were significantly higher and CGRP was significantly lower in high risk cardiac patients than normal control values 15 min after urapidial ET and NPY decreased significantly (P<0 01) and CGRP increased significantly (P<0 01) in high risk cardiac patients Conclusions In congestive heart failure and other high risk heart diseases urapidil can effectively improve the hemodynamics of these patients by reducing ET and NPY and increasing CGRP and deserves further study