升主动脉注射鱼精蛋白对体外循环后C3a和C5a的影响  

Impact of protamine injected into ascending aorta on C3a and C5a concentration in infants underwent cardiopulmonary bypass

作　　者：沈定荣[1] 张青[1] 王涛[1] 孟保英[1] 马超[1] 谭晓丽[1] 

机构地区：[1]广东省深圳市儿童医院心血管中心,518026

出　　处：《中国综合临床》2012年第8期831-833,共3页Clinical Medicine of China

基　　金：深圳市科技计划项目（200802063）

摘　　要：目的观察和评价通过升主动脉及上腔静脉注射鱼精蛋白不同注射途径对体外循环后婴儿血浆C3a、C5a的影响。方法年龄≤12个月行体外循环心内直视手术的患儿60例，应用随机数字表法随机分为实验组30例（经升主动脉注射鱼精蛋白组）和对照组30例（经腔静脉注射鱼精蛋白组）。于注射鱼精蛋白前（T1）、注射鱼精蛋白后1h（T2）取右心房肝素抗凝血1ml，用ELISA法测定血浆C3a、C5a浓度。结果实验组患儿注射鱼精蛋白前后血浆C3a浓度[（18．762±3．792）μg/L与（19．554±3．453）μg/L，t=-0．846，P=0．20]、C5a浓度[（0．843±0．159）μg/L与（0．825±0．119）μg／L，t=0．496，P=0．31]，差异均无统计学意义（P均〈0．05）；对照组患儿注射鱼精蛋白前后血浆C3a浓度[（18．780±3．864）μg／L与（22．961±3．501）μg/L，t=-4．392，P〈0．01]、C5a浓度[（0．839±0．157）μg／L与（0．979±0．116）μg／L，t=-3．928，P〈0．01]均显著增高。注射鱼精蛋白后1h对照组患儿血浆C3a浓度较实验组显著增高[（22．961±3．501）μg／L与（19．554±3．453）μg/L，t=-3．795，P〈0．01]、C5a浓度亦较实验组显著增高[（0．979±0．116）μg/L与（0．825±0．119）μg／L，t=-5．075，P〈0．01]。结论升主动脉途径注射鱼精蛋白可显著减少体外循环后婴儿血浆C3a、C5a浓度。Objective To observe and evaluate the changes in plasma C3a and C5a concentration after injecting protamine via two different pathways：ascending aorta and superior vena cava. Methods Sixty children with age under 1-year-old who underwent cardiopulmonary bypass were randomly divided into two groups： experimental group（ injecting protamine via ascending aorta, n = 30 ） and control group （ injecting protamine via superior vena cava,n = 30; ）. The plasma concentration of C3a and C5a were measured by ELISA at prior to protamine injected（Time 1 ）and 1 hour after the protamine injected（Time 2）. Results In experimental group, there was no statistical difference on C3a and C5a concentration before and after injection of protamine [ C3a： （ 18. 762 ± 3. 792） μg/L vs （ 19. 554 ± 3.453 ） μg/L, t = - 0. 846, P = 0. 20; C5a： （ 0. 843 ± 0. 159 ） μg/L vs （0. 825 ± 0. 119 ） μg/L, t = 0. 496, P = 0. 31 ]. In control group, C3 a concentration increased from （ 18.780 ± 3. 864）μg//L to（22. 961 ± 3. 501 ）μg/L, C5a concentration increased from（ 0. 839 ± 0. 157 ）μg/L to （0. 979 ± 0. 116） μg/L after injection of protamine, and the differences were significant （ t = - 4. 392, - 3. 928, respectively ,P 〈 0. 01 ）. The level of C3a concentration in experimental group was significantly higher than that in control group [ （ 19. 554 ± 3. 453 ） μg/L vs. （ 22. 961 ± 3.501 ） μg/L, t = 3. 795, P 〈 0. 01 ] after injection of protamine for 1 h and the level of C5a concentration exhibited the same change [ （0. 825 ± 0. 119） μg/L vs. （0.979±0. 116） μg/L,t = -5.075,P 〈0.01].Conclusion The levels of C3a and C5a concentration of infants underwent eardiopulmonary bypass are decreased significantly after protamine injected via ascending aorta compared with via superior vena eava.

关 键 词：鱼精蛋白 体外循环 肺保护 过敏毒素 

分 类 号：R654.2[医药卫生—外科学]