体外循环中体循环血浆内皮素-1的变化

目的观察体外循环(CPB)手术中体循环血浆内皮素-1(ET-1)的变化,并探讨其变化的原因.方法16例心脏病患者,于主动脉阻断前即刻,主动脉开放后1、3、5分,分别取升主动脉根部血及冠状静脉窦血,于主动脉阻断前即刻,主动脉开放10分,停CPB时分别取上、下腔静脉血和升主动脉根部血,测定血浆ET-1含量.结果主动脉阻断前即刻,主动脉开放后1、3、5分,冠状静脉窦血和升主动脉根部血血浆ET-1水平无显著差异;停CPB时下腔静脉血浆ET-1水平显著高于主动脉阻断前即刻(P＜0.05),也显著高于同时点升主动脉根部血血浆ET-1水平(P＜0.05).主动脉阻断前即刻,主动脉开放后10分,两者无显著差异;CPB期间上腔静脉血和主动脉根部血血浆ET-1水平无显著升高,两者也无显著差异.结论CPB手术中体循环血浆中升高的ET-1主要来源于腹部脏器,而不是心肌组织.

The Dynamic Change of Plasma Endothelin-1 Levels in Systemic Circulation during Cardiopulmonary Bypass

Objective: To investigate the changes of plasma endothelin-l (ET-l) levels in systemic circulation and the mechanism of the changes. Methods:We measured serum ET-1 levels of blood samples from aortic root,inferior vena cava and superior vena cava (right before aortic crossclamping,10 min after release of aortic crossclamping and right after cessation of (CPB), and from aortic root and coronary sinus (right before aortic crossclamping, and 1, 3, 5 min after release aortic crossclamping ). Results :ET-1 levels in inferior vena cava were significantly elevated right after CPB compared with the values right before aortic crossclamping. No significantly elevated ET-l levels was found in the samples from proximal aorta, coronary sinus and superior vena cava. There were no significant differences in ET-l levels between aortic root and inferior vena cava (right before aortic crossclamping, 10 min after release of aortic crossclamping), but ET-1 levels became higher in the samples from inferior vena cava than from aortic root after CPB. ET-1 levels were not significantly different between aortic root and superior vena cava or between aortic root and coronary sinus during CPB. Conclusion:The elevated ET-l during CPB may originate in some abdominal organs. It may not be associated with the increased myocardial production and secretion.