肝素涂抹体外循环装置减少补体系统的激活  

Heparincoated Circuits Reduce Complement Activation in Cardiopulmonary Bypass

作　　者：杨天宇[1] 龙村[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院体外循环科

出　　处：《中国循环杂志》1998年第2期94-96,共3页Chinese Circulation Journal

摘　　要：目的：本研究探讨体外循环（ＣＰＢ）使用肝素涂抹ＣＰＢ装置减少ＣＰＢ引起的补体系统激活，改善ＣＰＢ装置的生物相容性。方法：采用酶联免疫吸附方法测定ＣＰＢ过程中补体Ｃ３、Ｃ４及终末补体复合物Ｃ５ｂ～９的血浆浓度。成人择期心脏瓣膜替换术及冠状动脉旁路移植术２４例，随机分为对照组１２例采用Ｕｎｉｖｏｘ膜式氧合器；实验组１２例采用ＤｕｒａｆｌｏⅡ肝素涂抹ＣＰＢ装置。在ＣＰＢ前（肝素化后１０分）、ＣＰＢ３０分、升主动脉开放后１０分、ＣＰＢ结束即刻及鱼精蛋白中和肝素１０分５个时点进行观察。结果：白细胞计数，补体Ｃ３及Ｃ４血浆浓度两组均无明显变化（实验组鱼精蛋白中和肝素时点的白细胞明显增加）；补体Ｃ５ｂ～９血浆浓度ＣＰＢ中与ＣＰＢ前比均明显增加（Ｐ＜０．０５）；但组间有明显差异（Ｐ＜０．０１）。结论：肝素涂抹ＣＰＢ装置可以抑制补体系统激活，部分改善ＣＰＢ装置的生物相容性。? Objective:To study if the heparincoated circuits can reduce the activation of the complement in cardiopulmonary bypass. Methods:To evaluate whether the use of heparincoated circuits could reduce this activation process,we performed a study on 24 patients undergoing valve replacement and/or coronary artery bypass grafting who were randomly performed with a completely heparincoated circuits(Duraflo Ⅱ,n=12)as experimental group or with noncoated circuits(Univox,n=12)as control.Standardized systemic heparinization was applied for every patient before cardiopulmonary bypass.Blood samples were drawn 10 min after heparin administration,30 min into cardiopulmonary bypass,10 min after crossclamp removal,the end of cardiopulmonary bypass,and 10 min after protamine administration and was analyzed for leukocyte count,complement C 3,C4 and terminal complement complex(C5b～9)with enzymelinked immunoassay sorber. Results:Clinical and surgical results were similar in both groups.There were no significant differences between groups for complement C3,C4 or leukocyte count,except the leukocyte count was significantly increased after protamine administration in coated circuits.Terminal complement complex was significantly increased during cardiopulmonary bypass in both groups as compared with baseline value(p<005);furthermore,it was significantly different between the two groups,at most of the mentioned timepoints,it was lower in the experimental group(p<001). Conclusion:Heparincoated circuits might reduce the complement activation and partly improve biocompatibility of cardiopulmonary bypass circuits.

关 键 词：体外循环 肝素涂抹 体外循环系统 补体系统激活 

分 类 号：R654.1[医药卫生—外科学]