6％羟乙基淀粉(贺斯)预充液对体外循环血管内皮细胞损伤的保护作用  

Clinical study about the vascular endothelial cell protect effect of 6%HES during cardiopulmonary bypass (CPB)

作　　者：邓云坤[1] 安邦权[2] 李红[3] 陈静[1] 刚绍鹏[1] 舒义竹[4] 蓝萍[1] 

机构地区：[1]贵州省人民医院麻醉科,贵阳550002 [2]贵州省人民医院检验科,贵阳550002 [3]贵州省人民医院核医学科,贵阳550002 [4]贵州省人民医院心外科,贵阳550002

出　　处：《贵州医药》2005年第11期973-975,共3页Guizhou Medical Journal

基　　金：贵州省卫生厅优秀医学青年科技人才专项科研基金(1999-6)

摘　　要：目的 探讨贺斯体外循环(CPB)预充液对血管内皮细胞及血管通透性的影响。方法 选择心内直视手术40例,据预充液．的不同随机均分两组,即贺斯组(试验组)和全血组(对照组)。分 别于转流前、转流30分钟、转流结束、停机后6小时、术后第1天清晨取血及尿标本,测血中循环内皮 细胞(CEC)、内毒素、可溶性细胞间粘附分子-1(sICAM-1)、肿瘤坏死因子-α(TNF-α)及尿微量白蛋 白(U-Mal)的浓度。结果(1)CEC:两组转流30分钟、转流结束及停机后6小时明显增高(P<0．05), 停机后6小时试验组明显低于对照组(P<0．05)。(2)内毒素:两组转流开始后均显著升高(P< 0．01),术后第1天清晨,试验组恢复至转流前水平,对照组仍维持在较高水平(P<0．01);两组同期 比较,转流结束、停机后6小时、术后第1天清晨,对照组显著高于试验组(P<0．01)。(3)sICAM-1: 对照组停机后6小时及术后第1天清晨明显升高(P<0．05),试验组在停机后6小时升高幅度明显低 于对照组(P<0．05)。(4)TNF-α:在转流结束时对照组明显高于转流前及试验组同期(P<0．05)。 (5)U-Mal:两组停机后6小时升高(P<0．05),试验组升高的幅度明显低于对照组(P<0．01)。结论 CPB中贺斯预充液对血管内皮细胞及血管通透性具有明显的保护作用。Objective To investigate the benificial effect of 6% HES on vascular endothelial cell and its functions during CPB. Method Forty patients undergoing intra-cardiac surgery were randomly divided into two groups according to deffirent priming fluids for CPB, that is control group with total blood and HES group with 6%HES. Changes of plasma circulating endothelial cell（CEC）, endotoxin, soluble intercellular adhesion molecules-1 （sICAM-1）, tumor necrosis factor-α（TNF-α） and urinary micro-albumin（U-MaD were measured at before, 30min during CPB, termination of CPB , 6h after CPB, and the next day morning after operation. Results 1. The CEC elevated at 30min during CPB, termination of CPB and 6h after CPB（P〈0.05）. The CEC level in HES group was lower than in control group （P〈0. 05）. 2. The serum endotoxin in both group increased after the beginning of CPB（P〈 0. 01）. The serum endotoxin recovered to nomal in HES group level, but remained at high level in control group at next day moring. Comparing with the control group, the serum endotoxin level were lower in HES group at the termination of CPB, 6h after CPB and the next day morning after operation（P〈 0. 01）. 3. The serum sICAM-lin both group were elevated at 6h after CPB and the next day morning after operation. However, the elevation extent in HES group was lower at 6h after CPB（P〈0. 05）. 4. The serum TNF-α levels in control group at the termination of CPB were higher than before CPB and the same time point in HES group （P〈0. 05）. 5. The U-Mal in both group increased at 6h after CPB （P〈0. 05）. However the elevation extent in HES group were lower than in control group（P〈0. 01）. Conclusion Using 6% HES during CPB could effectively preserve the vascular endothelial cell and its function, still with lower cost.

关 键 词：体外循环 循环内皮细胞 内毒素 可溶性细胞间粘附分子-1 肿瘤坏死因子-α 尿微量白蛋白 

分 类 号：R654.1[医药卫生—外科学]