体外循环对血管内皮细胞及中性粒细胞弹性蛋白酶影响

目的 探讨体外循环(CPB)对血管内皮细胞的急性损伤/活化及中性粒细胞弹性蛋白酶(NE)的影响.方法 选取30例先天性心脏病患者,分别于体外循环前(T1),升主动脉阻断后15 min(T2),升主动脉开放后30 min(T3),升主动脉开放后60 min(T4)采集静脉血,测定血浆中性粒细胞弹性蛋白酶(NE)及肿瘤坏死因子-α(TNF-α),细胞黏附因子(sICAM)的含量.结果 NE、TNF-α、sICAM在升主动脉阻断15 min后己升高,升主动脉开放30 min后升至最高点,而后有下降趋势结论.NE与sI-CAM呈正相关(r=0.7826,P<0.05),并与TNF-α呈正相关(r=0.8256,P<0.05).结论 CPB可导致血管内皮细胞的广泛损伤/活化.血浆弹性蛋白酶的动态变化可提示血管内皮细胞的损伤程度.

Injury and activation of the vascular endothelial cells and the changs of neutrophil elastase during cardiopulmonary bypass

Objective To investigate vascular endothelial cell injurvation and the changs of neutrophil elastase during cardiopulmonary bypass.Methods A prospective randomized study was performed on 30 patients with acyanotic congenital heart disease undergoing corrective surgical procedures.Four blood samples were taken at the time points after anesthesia induction,15min after starting CPB,30min after opening aorta,and 60min after opening aorta,to measure the levels of NE,TNF-α,sICAM.Results The levels of NE,TNF-α,and sICAM were significantly elevated during CPB and raised to the top 30min immediately after opening aorta,as compared with those before CPB(P<0.01),although the concentration began to decease at T4 point.The changes of contents of NE and sICAM had positive correlation(r=0.7826,P<0.05).The changes of contents of NE and TNF-α had positive correlation(r=0.8256,P<0.05).Conclusion The injury and activation of vascular endothelial cell were induced by CPB,and the changes of content of NE in serum might be used to predict the serious degree vascular endothelial cell injury after CPB.