体外循环期间循环巨核细胞的变化及对术后神经系统并发症的影响  

Study the Changes of Circulating Megakaryocytes during Cardiopulmonary Bypass and Influence on Neurological Complications Postoperation in Changes

作　　者：肖大伟[1] 黄晓聪[1] 郑育举[1] 黄杰雄[2] 杨默[3] 霍泰辉[3] 李桂霞[3] 

机构地区：[1]汕头大学医学院第一附属医院心胸外科,广东汕头515041 [2]汕头大学医学院第一附属医院病理科,广东汕头515041 [3]香港中文大学儿科系

出　　处：《汕头大学医学院学报》2002年第4期199-202,共4页Journal of Shantou University Medical College

基　　金：广东省医学科学研究基金资助项目 (A2 0 0 0 43 9)

摘　　要：目的 :研究正常循环及体外循环期间巨核细胞的变化 ,说明其生理学及临床意义。方法 :观察测定 2 0例正常循环及体外循环手术期间肺前、后血的循环巨核细胞形态及数目 ,为循环巨核细胞释放出血小板的机理提供生理学证据 ,并观察术后精神神经系统表现。结果 :①正常循环时中心静脉血巨核细胞总数量高于周围动脉血巨核细胞总数量 (P <0 0 1) ,4 型巨核细胞数量差别更显著 (P <0 0 0 1)。②在体外循环期间 ,中心静脉血及周围动脉血巨核细胞总数量和 4 型巨核细胞数量均明显升高 (P <0 0 1)。③术后有神经系统症状者血液 4 型巨核细胞数量高于本组平均数 (5 12± 1 2 1) (P <0 0 1)。结论 :正常循环间肺部作为过滤器清除 4 型巨核细胞 ,体外循环期间巨核细胞未经肺循环而出现循环巨核细胞升高 。Objective:To study the changes of circulating megakaryocytes (MKs) on normal circulation and cardiopulmonary bypass(CPB).Methods:The numbers and morphosis of circulating MKs were determined and observed in 20 patients during the normal circulation and CPB,and the physiological evidence was offered for the mechanism of releasing platelets of the circulating MKs.Results:The total numbers of MKs of central venous were higher than those of eriphe -ral arteries during the normal circulation( P <0 01).There were significant differences between Type-4 MKs( P <0 001)and peripheral arteries.The total MKs among the central vein,peripheral arteries and Type-4 MKs were significantly increased during CPB( P <0 01).The numbers of Type-4 MKs in the patients of neurological impairement after CPB were significantly higher than those of total mean(5 12±1 2) ( P <0 01) Conclusion:The lungs as a filter may remove Type-4 MKs when the normal circulation.This physiological effect would be lost on CPB and it may be one of the causes of the neurological microembolism after CPB.

关 键 词：体外循环 巨核细胞 脑微栓塞 手术后并发症 

分 类 号：R654.1[医药卫生—外科学] R747.[医药卫生—临床医学]