室间隔缺损患者体外循环前后血浆内皮素、一氧化氮、心钠素水平的变化

Levels of plasma endothelin, nitric oxide and atrial natriuretic peptide after cardiopulmonary bypass and influence of inhaled nitric oxide in patients with ventricular septal defect and pulmonary hypertension

目的 探讨室间隔缺损 (VSD)伴肺动脉高压 (PH)患者体外循环 (CPB)前后血浆内皮素(ET 1)、一氧化氮 (NO)、心钠素 (ANP)水平变化及吸入NO对他们的影响。 方法 6 0例VSD患者 ,按有无PH分为无PH组 (A组 ) 2 0例 ,PH组 (B组 ) 4 0例。B组再随机分为吸入NO组 (B1组 )与不吸入NO组 (B2 组 )各 2 0例。分别测定血浆ET 1、NO、ANP含量。 结果 术前B组血浆ET 1、NO、ANP水平明显高于A组 (P <0 0 5 )。CPB后即刻 3组血浆ET 1水平明显高于术前 ,NO水平明显低于术前(分别P <0 0 5、P <0 0 1)。CPB后B1组血浆ET 1水平较B2 组下降快 ,NO水平较B2 组升高快。B组术前血浆ET 1浓度与血浆NO浓度呈负相关 ,与血浆ANP浓度呈正相关。 结论 ET 1/NO动态平衡的破坏 ,可能参与了PH的发生、发展过程 ;ANP在PH的发病机制中起着有益的生理调节作用。CPB使血浆ET 1升高 ,NO、ANP水平降低 ;吸入NO可降低ET 1水平 。

Objectives To assess the changes of the levels ofplasma endothelin (ET 1), nitric oxide (NO) and atrial natriuretic peptide (ANP) after cardiopulmonary bypass (CPB) and the influence of inhaled nitric oxide in patients with ventricular septal defect (VSD) and pulmonary hypertension(PH). Methods Sixty patients with VSD were enrolled in this study. They were divided into 2 groups: group A [no PH group, mean pulmonary artery pressure (mPAP)<20 mm Hg (1 mm Hg=0 133 kPa) n =20] and group B (PH group, mPAP>20 mm Hg, n =40). Group B was subdivided into two groups by randomized block, group B 1(inhaled NO group, n =20) and group B 2 (contrast group, n =20). The plasma ET 1, NO, ANP concentrations were assayed at 24 h pre operation and 0 h, 1 h, 5 h, 12 h, 24 h, 48 h after CPB. Results The preoperative plasma ET 1, NO and ANP concentrations in group B were significantly higher than those in group A. In three groups, the plasma ET 1 concentration at 0 h after CPB was significantly higher than that at 24 h pre operation, and the plasma NO concentration at 0 h after CPB was significantly lower than that at 24 h pre operation. In group B, the plasma ANP concentration at 0 h after CPB was significantly higher than that at 24 h pre operation. After CPB, the plasma ET 1 concentration in group B 1 decreased faster than that in group B 2, and the plasma NO concentration in group B 1 increased faster than that in group B 2. In group B, the preoperative plasma ET 1 concentration negatively correlated with the preoperative plasma NO concentration and positively correlated with the preoperative ANP concentration. Conclusions The broken dynamic balance of ET 1/NO may take part in generation and development of pulmonary hypertension. ANP acts as a favorable physiological regulating factor in the pathogenesis of pulmonary hypertension. CPB can regulate the level of ET 1 up and NO and ANP down while inhaled NO can cause the level of ET 1 down and the level of NO up.