停跳与不停跳心内直视术对血小板和P-选择素影响的对比研究  

A Contrasting Study of the Change of Platelet and P-selection Expression of Open-heart Surgery between Beating-heart and Arrested Heart

作　　者：林琦[1] 覃家锦[1] 冯旭[1] 

机构地区：[1]广西医科大学第一附属医院心胸外科,南宁市530021

出　　处：《广西医学》2009年第6期788-790,共3页Guangxi Medical Journal

基　　金：广西医疗卫生科学研究基金(桂卫Z2003022)

摘　　要：目的观察停跳与不停跳心内直视术对血小板及P-选择素表达的影响。方法风湿性心脏病患者40例,随机数字表法分成停跳组20例,在体外循环下行心脏停跳瓣膜置换术;不停跳组20例,在体外循环下行心脏不停跳瓣膜置换术。于术前(T1)、转机后20 min(T2)、转机后40 min(T3)、转机终了(T4)、手术终了(T5)、术后12 h(T6)、术后24 h(T7)分别采集静脉血,立即离心分离血清后置入-20℃冰箱保存,用酶联免疫吸附法测定P-选择素的浓度,用全自动分析仪检测血小板计数。结果两组P-选择素表达水平在心内直视术转机后开始升高,术后逐渐减弱,至术后24 h仍高于术前水平(P<0.01),但停跳组的升高和减弱程度均较不停跳组明显(P<0.01);两组血小板计数在心内直视术转机后开始下降,术后回升,至术后24 h仍低于术前(P<0.01),但停跳组的下降和回升程度均较不停跳组明显(P<0.01)。经直线回归与相关分析,心内直视术下血小板计数变化与P-选择素表达变化呈高度负相关(r=-0.964,P<0.01)。结论不停跳心内直视术及停跳下心内直视术均可使血小板计数降低、P-选择素表达增强,其中前者血小板计数降低程度及P-选择素表达增强程度均低于后者。Objective Contrast the change of platelcts and p-selection expression of open-beart surgery between beating-heart and arrested heart. Methods 40 patients were scheduled for elective cardiac valvular replacement were randomly divided into the model group and the control group by digital tabl. There were 20 patients in each group. Let the model group accept open-heart surgery with beating-heart and the control group accept open-heart surgery with arrested heart. Then we drew their blood from vein at preeperative （TI ）, CPB 20 min（T2 ）, CPB 40 min（T3） ,after the CPB（T4） ,after the operation（T5） ,12 h after the operation（T6） and 24 h after the operation（T7）. Results P-selection expression count of two groups was higher in open-heart surgery than that of the post-operation,and the value was weakened slowly. However,the count was still higher than that of the pre-operation （P 〈0.01 ） ,and the increased and decreased level of contol group was more significant than that of model group（P 〈0.01 ）. Moreover the blood platelets count was decreased in open-heart surgery and later recover in post-operation. The count was still lower than that of the pre-operation （P 〈0. 01 ） and the decreased and increased level of control group was more significant than that of model group（P 〈0. 01 ）. Person correlation between platelets and P-selection expression count was 0. 964（P 〈0. 01 ）. Conclusion Both platelets and P-selection expression was effected under open-heart surgery. But the influence under the open-heart surgery with beating-heart is lighter than open-heart surgery with arrested heart.

关 键 词：停跳 不停跳 心内直视术 血小板 P-选择素 

分 类 号：R654.2[医药卫生—外科学]