羟乙基淀粉130／0.4预充液对围体外循环期患儿血管内皮细胞及血管通透性的影响  

Effect of HES 130/0.4 priming solution on vascular endothelial cells and vascular permeability in children undergoing open-heart surgery under cardiopulmonary bypass

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,贵阳市550002 [2]贵州省人民医院检验科,贵阳市550002 [3]贵州省人民医院核医学科,贵阳市550002 [4]贵州省人民医院心外科,贵阳市550002

出　　处：《中华麻醉学杂志》2006年第10期932-935,共4页Chinese Journal of Anesthesiology

基　　金：贵州省卫生厅优秀医学青年科技人才专项科研基金资助项目(1999-6)

摘　　要：目的探讨羟乙基淀粉130／0．4预充液对先天性心脏病患儿围体外循环期血管内皮细胞(VEC)及血管通透性的影响。方法择期体外循环(CPB)下行心内直视手术的先天性心脏病患儿40例,ASAⅡ或Ⅲ级,男19例,女21例,年龄5～18岁,随机分为2组(n=20):血浆组(对照组)和羟乙基淀粉130／0．4组(试验组)。对照组预充乳酸林格氏液和血浆,试验组预充乳酸林格氏液和羟乙基淀粉130／0．4。胶体预充液用量18-33 m1·kg-1,晶体:胶体=0．60-0．70。分别于转流前即刻(T1)、转流30min(T2)、转流结束即刻(T3)、转流结束6 h(T4)、术后第1天清晨(T5)检测血浆循环内皮细胞(CEC)数量、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)浓度。结果．T1时两组CEC、内毒素、sICAM-1、TNF-α、U-Mal差异无统计学意义(P>0．05)。CEC:两组T2、T3及T4时较T1增高,T4时试验组低于对照组(P<0．05)。内毒素:两组T2、T3、T4时较T1升高,T3、T4、T5时试验组低于对照组(P<0．05)。sICAM-1:对照组T4、T5时较T1升高,T4时试验组低于对照组(P<0．05)。TNF-α:对照组T3时较T1升高,试验组低于对照组(P<0．05)。U-Mal:两组T4时较T1升高,试验组低于对照组(P<0．05)。结论羟乙基淀粉130／0．4预充液对先天性心脏病患儿围体外循环期VEC及其功能具有保护作用。Objective To investigate the beneficial effect of HES 130/0.4 used as priming solution on vascular endothelial cells and vascular permeability during cardiopulmonary bypass （CPB）. Methods Forty ASA Ⅱ or Ⅲ patients of both sexes （19 male, 21 female） aged 5-18 years weighing 15-52 kg undergoing open-heart surgery under CPB were randomly divided into 2 groups （ n = 20 each） ： group Ⅰ plasma and group Ⅱ HES 130/0.4. Colloid solution 18-33 ml·kg^-1 was added to priming solution. The amount of crystalline solution used as priming solution was the same in both groups. The crystalloid/colloid ratio was 0.60-0.70. Plasma circulating endothelial cells （CEC）, endotoxin, soluble intercellular adhesion molecule-1 （sICAM）, TNF-α and urinary micro-albumin （U-Mal） were measured before （T1） and at 30 min of CPB （T2）, termination of CPB （T3）, 6 h after CPB （T4） and on the morning of the 1 st postoperative day （T5）. Results The two groups were comparable with respect to demographic data, CPB time and duration of operation. The number of CECs was increased at T2, T3 and T4 as compared to the baseline （T1） in both groups and was significantly lower at T4 in HES group than in control group （group Ⅰ ） （P 〈 0.05）. The plasma endotoxin, sICAM-1, TNF-α and u-Mal levels were significantly increased at different time points during and after CPB as compared to the baseline values before CPB and HES attenuated the CPB-induced increases. Conclusion HES 130/0.4 added to priming solution during CPB can effectively protect the vascular endothelial cells and their function.

关 键 词：羟乙基淀粉 心肺转流术 内皮细胞 

分 类 号：R726.1[医药卫生—儿科]