血浆内源性洋地黄样物质在围体外循环期的动态变化

目的探讨围体外循环(CPB)期患者血浆内源性洋地黄样物质(EDLS)浓度的变化及对心功能的影响。方法29例心功能分级(纽约心脏学会分级)为~级的先天性或后天性成年心脏病患者纳入研究。分别于CPB前、停机、术后2 h、6 h、1 d和3 d取静脉血,放免法测定血浆EDLS浓度。结果级心功患者术前血浆内EDLS浓度〔(403±27)pg/mL〕显著高于级〔(221±98)pg/mL,P<0.01〕和级患者〔(296±71)pg/mL,P<0.01〕。CPB能够引起EDLS的浓度升高,至术后2 h〔(683±371)pg/mL〕和6 h〔(577±274)pg/mL〕达峰值,显著高于术前〔(324±79)pg/mL,P<0.01〕,术后24 h恢复至术前水平。然而,无论在手术后2 h或6 h,高浓度EDLS(>1000 pg/mL)患者血压和正性肌力药物的使用与中等浓度(401~999 pg/mL)和低浓度EDLS(<400 pg/mL)患者差异无统计学意义,但术后高浓度EDLS组级心功患者比例(术后2 h:50%;术后6 h:63%)显著高于低浓度组(术后2 h:0%;术后6 h:8%)和中等浓度组(术后2 h:11%;术后6 h:30%)。相关性分析显示,手术后2 h和6 h血浆EDLS浓度与升主动脉阻断时间无关(r分别为0.0748和0.0393)。结论心力衰竭和CPB手术均能够引起EDLS的释放。手术后2~6 h血浆EDLS的浓度迅速升高。高浓度的EDLS与心脏缺血损伤的严重程度无关,但可能增强心功能。

Change of Serum Endogenous Digitalis-like Substance Undergoing Cardiopulmonary Bypass

OBJECTIVE: To investigate the plasma concentrations and cardiac effects of endogenous digitalis-like substance (EDLS) before and after cardiopulmonary bypass (CPB). METHODS: 29 adults patients with NYHA II - IV, who suffered from congenital and acquired heart diseases, were included in this study. The plasma EDLS levels were determined by radioimmunoassay before and at the end of CPB, 2 h, 6 h, 24 h and 3 days after operation. RESULTS: The plasma EDLS concentrations in NYHA IV patients [(403 +/- 27) pg/mL] were significantly higher than those in II [(221 +/- 98) pg/mL] and III patients [(296 +/- 71 pg/mL), P < 0.01] before CPB. CPB could induce the release of EDLS. The EDLS concentrations in plasma increased to (683 +/- 371) pg/mL and (577 +/- 274) pg/mL at 2 h and 6 h respectively after CPB, and went back to normal at 24 h after operation. However, there was no relationship between plasma EDLS concentration and the time of ascending aorta blocked at 2 h or 6 h after operation (r = 0.0748 and 0.0393 respectively). Over 50% patients in the higher EDLS (> 1000 pg/mL) group are NYHA IV, and the ratio was significantly higher than that in lower EDLS group (< 999 pg/ mL, P < 0.05). There was no difference between higher and lower EDLS groups in respect of the requirement of inotropic support and blood pressure. CONCLUSIONS: The EDLS release can be induced by heart failure and CPB. The plasma EDLS concentrations increase up to climax in 2-6 h after CPB. The higher plasma EDLS concentration may improve the cardiac function.