前列腺素E_1在心肺转流过程中对血小板功能影响的研究  

The study on the infuleunce of prostaglandin E_1 on platelet function during cardiopulmonary bypass

作　　者：桑永华[1] 陈亮[1] 赵飞[1] 

机构地区：[1]南京医科大学第一附属医院心胸外科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2008年第6期762-766,共5页Journal of Nanjing Medical University(Natural Sciences)

摘　　要：目的:研究前列腺素E1(PGE1)在心肺转流(CPB)过程中对血小板的影响。方法:选取行CPB下瓣膜置换手术的风湿性心脏病患者24例,随机分成实验组(PGE1干预组)和空白对照组,每组12例。用放射-免疫法分别检测肝素化后(T1)、CPB30min(T2)、CPB结束时(T3)和结束后1h(T4)动脉血中的血栓烷B2(TXB2)、6-酮-前列腺素F1α(6-K-PGF1α)的浓度,并用透射电镜观察T1,T2,T3时血小板超微结构的变化。结果:2组中TXB2、6-K-PGF1α在T2、T3时均较T1时明显升高(P<0.01),T3时达到最高,T4时恢复至CPB前水平。在T2、T3时6-K-PGF1α实验组明显高于对照组(P<0.01),而TXB2及二者比值TXB2/6-K-PGF1α则明显低于对照组(P<0.01)。电镜观察中,对照组未活化(圆型和展平型)的血小板在CPB中均较实验组明显减少,而活化(聚集型和树突型)的血小板明显较实验组增加(P<0.01)。结论:PGE1能抑制CPB引起的血小板活化,保护血小板功能,降低血小板损耗,减轻凝血功能紊乱,减少术后血液丢失。Objective：To study the protective effect of prostaglandin E1（PGE1） on platelet during cardiopulmonary bypass（CPB）.Methods：A total of 24 patients with rheumatic heart disease undergoing cardiac valve replacement were randomly divided into the experimental group（n = 12） and the control group（n = 12）. The levels of TXB2 and 6-K-PGF1α in serum were measured at different intervals during and after CPB. The ultrastructure of platelets were also observed with transmission electron microscope. Results：The levels of TXB2 and 6-K-PGF1α during CPB were significantly higher than those before CPB in both groups（P 〈 0.01）, and reached the highest at the end of CPB,then retrieved as before CPB. During CPB,the level of 6-K-PGF1α in the experimental group was significantly higher than that in the control group,while TXB2/6-K-PGF1α and the level of TXB2 were significantly lower than those in the control group（P 〈 0.01）. Meanwhile,the number of unactivated platelets in the control group decreased more obviously than those in the experimental group during the CPB,while the number of activated ones increased（P 〈 0.01）. Conclusion：PGE1 could effectively inhibit the activation of the platelets,protect their function and decrease their loss during the CPB,then reduce the coagulopathy resulted by CPB,reduce the amount of postoperative bleeding.

关 键 词：前列腺素E1 心肺转流 血栓烷B2 6-酮-前列腺素F1 血小板超微结构 

分 类 号：R654.2[医药卫生—外科学]