川芎嗪对先天性心脏病伴肺动脉高压体外循环下内皮素、von Willebrand因子和血栓素A2的影响

目的 :观察川芎嗪 (tetramethylpyrazine,TMP)对先天性心脏病 (先心病 )伴肺动脉高压体外循环(CPB)下血管内皮细胞 (vascularendothelialcell,VEC)相关的体液因子内皮素 (endothelin ,ET)、因子Ⅷ相关抗原 (vonWillebrandfactor ,vWF)、血栓素A2 (TXA2 )的影响并探讨这些改变的临床病理生理学意义。方法 :将 30例非紫绀型先心病肺动脉高压患者随机分为对照组和用药组 ,用药组于麻醉诱导后静脉滴注TMP3mg/kg体重 ,转流后于氧合器中追加 1mg/kg体重。于麻醉诱导后、转流 15min、升主动脉开放 5min、停体外循环机后 2 0min、6h及 2 4h从桡动脉穿刺管中采血 ,测定血浆中ET、vWF及TXA2 的稳定代谢产物TXB2的含量 ,计算停机后 6h的肺血管反应性、机械辅助呼吸时间。结果 :体外循环下ET、vWF和TXB2 均明显上升 ,但用药组上升幅度明显小于对照组 (P <0 0 5 ) ,且停机后 6h的肺血管反应性、机械辅助呼吸时间也短于对照组。结论 :TMP能显著减少先心病肺动脉高压体外循环 (CPB)下ET、vWF和TXB2 的产生和减轻术后肺血管反应性的上升幅度。说明TMP能减轻CPB对VEC的损伤作用 ,有利于提高术后疗效。

Effect of Tetramethylpyrazine on Endothelin,von Willebrand Factor and Thromboxane A2 during Cardiopulmonary Bypass in Patients of Congenital Heart Disease with Pulmonary Hypertension

OBJECTIVE: To study the effect of tetramethylpyrazine (TMP) on the vascular endothelial cell (VEC) related humoral factors, including endothelin (ET), factor VIII related antigen (i.e. von Willebrand factor, vWF) and thromboxane A2(TXA2) in patients of congenital heart disease with pulmonary hypertension (CHD-PH) during cardiopulmonary bypass (CPB), and explore the clinical physiopathologic significance of them. METHODS: Thirty non-cyanotic patients of CHD-PH were randomly divided into the control group and the treated group. TMP was given to the treated group by intravenous dripping 3 mg/kg after anesthesia induction and adding 1 mg/kg in oxygenator during CPB. Blood samples were collected from radial artery at the time points of after anesthesia induction, 15 min after beginning CPB, 5 min after opening aorta, 20 min, 6 hrs and 24 hrs after stopping CPB, to determine the plasma contents of ET and vWF, as well as TXB2, the stable metabolite of TXA2. The pulmonary vascular reactivity 6 hrs (6h-PVR) after CPB and the mechanical ventilatory support time (VST) after operation were calculated. RESULTS: Levels of ET, vWF and TXB2 increased obviously during CPB, but the degree of increasing in the treated group was lower than that in the control group (P < 0.05), and the 6h-PVR and VST in the former were also lower than those in the latter respectively. CONCLUSION: TMP could obviously reduce the production of ET, vWF and TXB2 during CPB and relieve the pulmonary vascular reactivity after operation, indicating that TMP could reduce the injury of CPB on VEC, and is benefit to enhance the efficacy of treatment.