血浆内源性洋地黄样物质在围体外循环期的动态变化  

Change of Serum Endogenous Digitalis-like Substance Undergoing Cardiopulmonary Bypass

作　　者：罗彤[1] 芮军[1] 黎新建[1] 张力[1] 张志国[1] 仇滔[1] 袁武[1] 罗勇[1] 方冰[1] 

机构地区：[1]四川省成都市第三人民医院胸心外科,成都610031

出　　处：《四川大学学报（医学版）》2008年第2期272-275,共4页Journal of Sichuan University(Medical Sciences)

摘　　要：目的探讨围体外循环（CPB）期患者血浆内源性洋地黄样物质（EDLS）浓度的变化及对心功能的影响。方法29例心功能分级（纽约心脏学会分级）为Ⅱ～Ⅳ级的先天性或后天性成年心脏病患者纳入研究。分别于CPB前、停机、术后2h、6h、1d和3d取静脉血，放免法测定血浆EDLS浓度。结果Ⅳ级心功患者术前血浆内EDLS浓度[（403±27）pg／mL]显著高于Ⅱ级[（221±98）pg／mL，P〈0．01]和Ⅲ级患者[（296±71）pg／mL，P〈0．01]。CPB能够引起EDLS的浓度升高，至术后2h[（683±371）pg／mL]和6h[（577±274）pg／mL]达峰值，显著高于术前[（324±79）pg／mL，P〈0．01]，术后24h恢复至术前水平。然而，无论在手术后2h或6h，高浓度EDLS（〉1000pg／mL）患者血压和正性肌力药物的使用与中等浓度（401～999pg／mL）和低浓度EDLS（〈400pg／mL）患者差异无统计学意义，但术后高浓度EDLS组Ⅳ级心功患者比例（术后2h：50％；术后6h：63％）显著高于低浓度组（术后2h：0％；术后6h：8％）和中等浓度组（术后2h：11％；术后6h：30％）。相关性分析显示，手术后2h和6h血浆EDLS浓度与升主动脉阻断时间无关（r分别为0．0748和0．0393）。结论心力衰竭和CPB手术均能够引起EDLS的释放。手术后2～6h血浆EDLS的浓度迅速升高。高浓度的EDLS与心脏缺血损伤的严重程度无关，但可能增强心功能。Objective To investigate the plasma concentrations and cardiac effects of endogenous digitalislike substance （EDLS） before and after cardiopulmonary bypass （CPB）. Methods 29 adults patients with NYHA Ⅱ -Ⅳ, who suffered from congenital and acquired heart diseases, were included in this study. The plasma EDLS levels were determined by radioimmunoassay before and at the end of CPB, 2 h, 6 h, 24 h and 3 days after operation. Results The plasma EDLS concentrations in NYHA Ⅳ patients [（403±27） pg/mL] were significantly higher than those in Ⅱ [（221±98） pg/mL] and Ⅲ patients [（296±71 pg/mL）, P〈0. 01] before CPB. CPB could induce the release of EDLS. The EDLS concentrations in plasma increased to （683±371） pg/mL and （577±274） pg/mL at 2 h and 6 h respectively after CPB, and went back to normal at 24 h after operation. However, there was no relationship between plasma EDLS concentration and the time of ascending aorta blocked at 2 h or 6 h after operation （r=0. 0748 and 0. 0393 respectively）. Over 50% patients in the higher EDLS （〉1000 pg/mL） group are NYHA Ⅳ, and the ratio was significantly higher than that in lower EDLS group （〈999 pg/ mL, P〈0. 05）. There was no difference between higher and lower EDLS groups in respect of the requirement of inotropic support and blood pressure. Conclusions The EDLS release can be induced by heart failure and CPB. The plasma EDLS concentrations increase up to climax in 2-6 h after CPB. The higher plasma EDLS concentration may improve the cardiac function.

关 键 词：内源性洋地黄样物质 心功能 体外循环 

分 类 号：R654.1[医药卫生—外科学]