瑞芬太尼预处理对体外循环患者血管内皮细胞保护作用的研究

目的 研究瑞芬太尼预处理对体外循环（CPB）患者血浆血栓调节蛋白（TM）和血管性假血友病因子（vWF）水平的影响,探讨瑞芬太尼对血管内皮细胞的保护作用.方法 选择40例择期体外循环下行二尖瓣置换患者,随机分为2组：Ⅰ组（瑞芬太尼预处理组）;Ⅱ组（生理盐水对照组）.在CPB前（T1）,CPB 30 min（T2）,体外循环停机后0 h（T3）、6 h（T4）,24 h（T5）,72 h（T6）分别采集静脉血,应用标记特异性抗体CD146的免疫磁珠技术分离循环内皮细胞（CEC）并计数,应用酶联免疫吸附试验（ELISA）、γ放射免疫法等技术分别检测TM、vWF、氧化亚氮（NO）、内皮素-1（ET-1）含量.结果 2组患者在CPB前比较,CECs无显著差异,但在T3、T4、T5、T6,Ⅱ组CECs数量明显高于Ⅰ组（P＜0.05）.在CPB结束后的T3、T4、T5点Ⅰ组的TM、vWF浓度均较Ⅱ组低,差异有统计学意义（P＜0.05）.Ⅰ组ET-1浓度在T2、T3、T4、T5均较Ⅱ组低,差异有统计学意义（P＜0.05）.Ⅰ组NO浓度在T4、T5两个时间点明显高于Ⅱ组,差异有统计学意义（P＜0.05）.结论 瑞芬太尼预处理能够降低CPB后TM和vWF表达,并减少CEC脱落和ET的产生,较好地维持血浆NO/ET的平衡,从而发挥血管内皮细胞的保护作用.

Effect of remifentanil preconditioning on protection of vascular endothelial in patients with open heart surgery during cardiopulmonary bypass

Objective To investigate the effect of remifentanil preconditioning on the levels of thrombomodulin （TM） and von willebrand factor （vWF） during cardiopulmonary bypass （CPB） and explore the protective effect of remifentanil on vascular endothelial. Methods 40 patients underwent CPB for mitral valve replacement were randomly divided into remifentanil preconditioning group （group Ⅰ , n = 20） and control group （group Ⅱ , n = 20）. Vein blood samples of each patient were taken before CPB （T1） at 30 minutes during CPB （T2） and at 0 hour （T3）, 6 hours （Ta）, 24 hours （T5）, 72 hours （T6） after termination of CPB. Circulating endothelial cells （CEC） were isolated and counted by using dynabeads coated with the specific antibody of CD146. ELISA was used to detect the levels of plasma TM and vWF. Results There was no significant difference in counts of CECs before CPB between two groups. In group , the number of CECs was significantly greater than that in group I at T3, T4, T5, T6 （P 〈 0.05）. Compared with group Ⅱ , the plasma concentrations of TM and vWF were significantly lower at T3 ,T4 ,T5 in group I （P〈0.05）. The plasma concentrationof ET-1 in group I was significantly lower than that in group Ⅱ at T2, T3, T4, T5 （P 〈 0.05）. Compared with group Ⅱ , the concentration of NO was significantly higher in group Ⅰ at T4, T5 （P 〈 0.05）. Conclusion Remifentanil preconditioning may play an important role in endothelial cells protection by reducing the expression of TM and vWF. By inhibiting the production of ET and detachment of CEC, it can maintain balance of NO/ET in plasma and protect the endothelial cells.