体外循环对血清同型半胱氨酸水平影响临床探究.doc

体外循环对血清同型半胱氨酸水平影响临床探究 　 作者：马晓辉，高长青，李伯君，刘静 【摘要】 　　目的 探讨体外循环是否可引起冠脉搭桥术后血清同型半胱氨酸（Hcy）水平升高。 方法 测定40例患者（分体外循环和非体外循环组，各20例）术前第1天、术后第1天、3天、5天、7天血清Hcy、铜离子、铜兰蛋白的浓度，并记录相应时间点的肝功能、肾功能、血糖、血脂及肌酸激酶水平。结果 铜兰蛋白、铜离子和Hcy分别于术后约第3天、4天、6天明显升高，术后早期肝功能、肾功能、血糖及肌酸激酶水平显著升高，至术后第5天左右基本恢复到术前水平， 血脂水平手术、前后无明显改变。上述指标两组间比较均无显著差异。结论 体外循环会对肝功能造成可逆性损伤，但不是引起搭桥术后血清Hcy水平升高的原因。 【关键词】 同型半胱氨酸　体外循环　冠状动脉旁路移植术 　　Clinical Study about the Influences of Extracorporeal Circulation to Abstract: OBJECTIVE To investigate whether extracorporeal circulation is the reason for the increases of plasma homocysteine (Hcy) levels after surgery. METHODS Blood samples were taken from 40 patients(20 patients with coronary artery bypass and others with off-pump coronary artery bypass ) 1 day preoperatively and postoperatively at 1 day, 3 days, 5 days, and 7 days. Hcy, copper, ceruloplasmin and other parameters such as liver and renal function, blood sugar, and creatinkinase were then measured using clinical chemistry methods. RESULTS There were significant increases in the plasma concentrations of ceruloplasmin at 3 days postoperatively, copper at 4 days, Hcy at 6 days . Other parameters increased significantly after operation, then return to the levels preoperatively. These analysis showed the same trend between two groups. CONCLUSION Extracorporeal circulation may not be the reason for the increases of Hcy levels after operation, but it can damage the liver function temporarily. Key words： Homocysteine; Extracorporeal circulation; Coronary artery bypass 冠状动脉旁路移植术后血清同型半胱氨酸（Hcy）水平会持续升高［1］，且体外实验已证实血清Hcy水平与铜离子浓度的变化关系密切［2］。已研究发现搭桥术后血清铜离子浓度升高可能是导致术后Hcy水平增加的主要原因［3］，但搭桥术后早期体外循环对铜离子浓度和Hcy水平的变化有无影响未见国内外有报道，本文旨在这方面作初步探讨。 1 资料与方法 1.1 临床资料 将择期行冠状动脉旁路移植术的患者分为体外循环组(CCABG组)和非体外循环组 (OPCAB组)，各20例。排除再次手术及术前合并急性心肌梗死、肝、肾功能障碍、甲状腺功能低下及急、慢性感染者，也排除行急诊手术和已在内科行介入治疗者。 1.2 方法 OPCAB组放置血管稳定器（Octops III型）固定靶血管，CCABG组常规插管建立体外循环，升主动脉根部顺行灌注氧合血停跳液保护心肌，使用乳内动脉和大隐静脉与冠状动脉靶血管吻合 ,最后完成大隐静脉桥和升主动脉吻合。清晨、空腹、卧位采取肘静脉血，常温下送至相应科室立即离心标本，Hcy、铜离子和铜兰蛋白标本冻存待测，其它标本当天检测，所有标本在征得