血浆内皮素水平在心内直视手术期间的动态变化及其临床意义  

DYNAMIC CHANGE OF PLASMA ENDOTHELIN-1 DURING THE PERIOPERATIVE PERIOD OF OPEN-HEART SURGERY AND ITS CLINICAL SIGNIFICANCE

作　　者：祝志刚[1] 王敏生[1] 蒋振斌[1] 石美鑫[1] 任长裕 姜桢[1] 许叔祥 

机构地区：[1]上海医科大学中山医院心脏外科 [2]上海南洋医学放射免疫中心

出　　处：《上海医科大学学报》1995年第6期419-424,共6页Journal of Fudan University(Medical Science)

基　　金：中华医学基金(CMB)资助

摘　　要：对15例风湿性心脏瓣膜病继发肺动脉高压患者,在心内直视手术围术期期间进行了血流动力学与血浆内皮素-1(ET-1)水平变化的动态监测。发现:①患者术前血浆ET-1水平显著升高,为健康对照者的3倍,且与肺循环血流动力学指标如肺动脉压、肺毛细血管楔压、肺循环血管阻力等呈正相关。随着瓣膜置换术后肺循环的改善,血浆ET-1水平迅速下降;②血浆ET-1水平在体外循环期间显著持续的上升并在体外循环结束时达到峰值。峰值ET-1水平与体外循环持续时间呈正相关,而与体外循环期间尿量呈负相关。推论:①ET-1可能参与和加速了继发性肺动脉高压的病理进程,血浆ET-1水平可作为衡量风心病患者继发肺动脉高压严重程度的指标之一;②显著增高的ET-1可能与长时间体外循环后的心、肾功能障碍有关。Fifteen rheumatic valvular disease patients with secondary pulmonary hypertension underwent continual hemodynamic monitoring and dynamic measurement of plasma endothelin-1 (ET-1) concentration during the perioperative period. The plasma ET-1 concentration was found twofold greater in patients than that in the healthies and the preoperative plasma ET-1 level was positively correlated with the pulmonary hemodynamic parameters such as pulmonary artery pressure, pulmonary capillary wedge pressure and pulmonary vascular resistance. The plasma ET-1 concentration declined rapidly when pulmonary hemodynamics markedly improved after operation. The plasma ET-1 concentration was also found significantly increased during the course of cardiopulmonary bypass (OPB) and peaked at the end of OPB. The maximal ET-1 level correlated positively with the duration of OPB but negatively with the urine volume during OPB. It is concluded from the present study: (1) the plasma ET-1 level might be considered one of the indicators for the severity of secondary pulmonary hypertension in rheumatic valvular disease; (2) the markedly elevated plasma ET-1 is supposed to be associated with the cardiac or renal dysfuntion aftir prolonged OPB.

关 键 词：内皮素 风湿性 心脏瓣膜病 心内直视术 

分 类 号：R654.2[医药卫生—外科学]