体外循环中血浆一氧化氮及内皮素变化临床观察.docVIP

体外循环中血浆一氧化氮及内皮素变化临床观察 　 作者：孙新艳 吴新军 马支媛 张宁 王俊科 【关键词】 内皮素 摘要：目的 观察体外循环（CPB）转流前后血浆中一氧化氮（NO）和内皮素（ET）的含量变化。方法　选择CPB下心内直视手术病人21例，分别在手术前、转流前、转流5min、转流30min、停止转流前、停CPB后1h，采血样4ml，用于NO及ET测定。结果 手术前血浆中NO为（3.64±0.61）nmol/ml，转流前及CPB5min时分别为(3.62±0.64)nmol/ml和(3.57±0.72)nmol/ml与术前比没有显著性差异Pgt;0.05，NO在 CPB30min、停止转流前及停机后1h明显升高为(5.90±1.11)nmol/ml、(5.82±1.25)nmol/ml和(5.71±1.22)nmol/ml，与术前比有明显升高Plt;0.01。手术前ET为(11.47±2.58)pg/ml，转流前及CPB5min分别为(11.16±2.39)pg/ml和(10.89±2.43)pg/ml，与术前比无显著性差异Pgt;0.05，CPB30min时ET降至最低点为(6.79±2.30)pg/ml，与术前比有显著性差异（Plt;0.01），之后随转流时间增加ET逐渐回升，到停止转流前升至最高点为(14.6±3.10)pg/ml明显高于术前水平Plt;0.01，停机后1h为（14.34±2.97）pg/ml仍高于术前水平Plt;0.01。结论 CPB是一个典型的缺血再灌注损伤过程，可诱发一系列复杂的全身性炎症反应，可导致血浆中NO、ET浓度显著升高，且持续至停机1h。 　　关键词：体外循环；一氧化氮；内皮素； 　　Effects of Extracorporeal Circuation on the Changes of Plasm　Nitric Oxide and Endothelin Before and After Perfusion 　　Abstract: OBJECTIVE To oberserve the changes of nitric oxide (NO) and endothlin (ET) in plasm before and after extracorporeal circulation.METHODS 21Patients undergoing intracardial surgey under extracorporeal circulation were selected and 4ml blood was sampled before operation, before perfusion, 5mi nafter perfusion,30min after perfusion,before the end of perfusion and 1h after the end of extracorporeal circulation respectively.RESULTS Mean level of NO in plasm was 3.64±0.61 before operation 3.62±0.64 before perfusion and 3.57±0.72 at 5min after CPB,There were no statistic differences (Pgt;0.05).NO increased significantly at 30min after begining of CPB 5.90±1.11,before the end of perfusion 5.82±1.25 and 5.71±1.22 at 1h after the end of extracorporeal circulation (Plt;0.01). ET was 11.47±2.58 before operation,11.16±2.39 before perfusion and 10.89±2.43 at 5 min after begining of CPB respectively.There were no difference(Pgt;0.05). At 30min after CPB ET decreased to the lowest level 6.79 ±2.30 and difference was significant compared with that before operation (Plt;0.01) After that ET increared progressively following increase of perfusion pe