周围体外循环对胸腔镜二尖瓣置换手术患者血清TXB2水平的影响及临床意义

Effect of peripheral cardiopulmonary bypass on serum TXB2 level in patients undergoing thoracoscopic mitral valve replacement surgery and its clinical significance

目的探讨周围体外循环对胸腔镜二尖瓣置换手术患者术侧股静脉插管远心端、上腔静脉血清血栓素B2(TXB2)的影响及临床意义。方法选取2017年12月-2020年12月于本院行胸腔镜二尖瓣置换手术的40例患者为研究对象,患者均通过股动、静脉插管建立周围体外循环。采用酶联免疫吸附(ELISA)法检测术侧股静脉插管远心端、上腔静脉血清TXB2、组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制物-1(PAI-1)水平;采用Pearson法分析体外循环转机前、后术侧股静脉插管远心端、上腔静脉血清TXB2与t-PA、PAI-1水平相关性。结果体外循环转机后术侧股静脉插管远心端、上腔静脉血清TXB2、PAI-1高于转机前,t-PA水平低于转机前,差异有统计学意义(P<0.05);体外循环转机后术侧股静脉插管远心端与上腔静脉血清TXB2、t-PA、PAI-1水平比较,差异无统计学意义(P>0.05);体外循环转机前、后术侧股静脉插管远心端血清TXB2与PAI-1水平呈正相关(P<0.05),与t-PA呈负相关(P<0.05);体外循环转机前、后上腔静脉血清TXB2与PAI-1水平呈正相关(P<0.05),与t-PA呈负相关(P<0.05)。结论周围体外循环转机后心脏疾病患者术侧股静脉插管远心端、上腔静脉血清中TXB2明显升高,提示临床医师术后应尽早抗凝,有助于降低血栓形成风险。

Objective To investigate the effect and clinical significance of peripheral cardiopulmonary bypass on serum thromboxane B2(TXB2)in patients undergoing thoracoscopic mitral valve replacement surgery.Methods From December 2017 to December 2020,40 patients who underwent thoracoscopic mitral valve replacement surgery in our hospital were selected as the research objects.The patients were all used to establish peripheral cardiopulmonary bypass through femoral arteriovenous catheterization.Enzyme-linked immunosorbent assay(ELISA)was used to detect serum TXB2,t-PA and PAI-1 level at the distal end serum of cannulated femoral vein on the surgical side and the superior vena cava serum.The Pearson method was used to analyze the correlation between serum TXB2 of the distal end serum of cannulated femoral vein on the surgical side and the superior vena cava serum and the level of t-PA,PAI-1 before and after cardiopulmonary bypass.Results The serum TXB2,PAI-1 of the distal end serum of cannulated femoral vein on the surgical side and superior vena cava serum after cardiopulmonary bypass were higher than those before cardiopulmonary bypass,and the levels of t-PA were lower than those before cardiopulmonary bypass,the differences were statistically significant(P<0.05).After cardiopulmonary bypass,there was no significant difference in serum TXB2,PAI-1,and t-PA levels between the distal end serum of cannulated femoral vein on the surgical side and superior vena cava serum(P>0.05).Serum TXB2 level at the distal end serum of cannulated femoral vein on the surgical side before and after cardiopulmonary bypass was positively correlated with PAI-1 level(P<0.05),and negatively correlated with t-PA(P<0.05).Serum TXB2 level of the superior vena cava before and after cardiopulmonary bypass was positively correlated with PAI-1 level(P<0.05),and negatively correlated with t-PA(P<0.05).Conclusion In patients undergoing thoracoscopic mitral valve replacement surgery after peripheral cardiopulmonary bypass,the level of TXB2 is significantly increased in distal end serum of cannulated femoral vein on the surgical side and superior vena cava serum,which suggests that clinicians should anticoagulate as soon as possible after surgery,which can help reduce the risk of thrombosis.