术前应用激素对减少体外循环心脏手术后出血作用的研究

目的：观察地塞米松对CPB心脏手术前后纤溶调节系统（PAI／tPA)的影响。方法：对1998年10月至2000年10月间救治的44例行CPB心脏手术病人随机分为对照组和干预组。干预组在术前8h给予肌注地塞米松0.3mg/kg体重，于手术前1天，手术后1、6、24h4个时点采集桡动脉血。应用酶联免疫吸附法（ELISA）检测血液组织型纤溶酶原激活物（tPA)和组织型纤溶酶原激活物抑制剂（PAI）含量，同时记录术后24h心包纵隔引流量。结果：干预组PAI水平要后各时点显著高于术前水平（P＜0．05），而且高于对照组术后相应各时点水平（P＜0．05）。干预组tPA水平各术时点与术前比较无显著差异，但与对照组各时点比较普遍降低。术后24h心包纵隔引流量干预组明显低于对照组。结论：CPB心脏手术前使用地塞米松可以保护血管内皮细胞，维持血液PAI和tPA比值平衡，减轻纤溶亢进，达到减少术后出血的作用。地塞米松价格便宜，获得方便，可为病人节省大笔医疗费用。

Research of the affect of using simple dose hormone preoperation to reduce postoperative bleeding

Objective:To observe the effect of dexamethasone on fibrinolytic regulatory system before and after cardiopulmonary bypass(CPB) cardiac surgery.Methods:Forty-four patients with CPB cardiac surgery from October in 1998 to October in 2000 were random sampling and divided into two groups:the experimental group and the control group.The experimental group was given dexamethasone 0 3 mg/kg before operation 8 hours,the blood samples from radialis artery were collected before operation 1 day and postoperation 1 6 24 hrs.Tissue plasminogen activator(tPA) and plasminogen activator inhibitor(PAI) were detected by enzyme-linked immunosorbent assay(ELISA),meanuhile the drainage dose of pericardium and mediastinum in postoperative 24 hrs was recorded.Results:The postoperative level of PAI in the experimental group was obviously higher at each time point than that of preoperation(P<0 05),and which were notably higher at relevant each time point than that of postoperation in the control group(P<0 05).The postoperative level of tPA at each time point in the experimental group was not obviously different from that of preoperation,but they were general lower at each time point than that in the control group.The drainage dose of pericardium and mediastinum in postoperative 24 hrs in the experimental group was obviously lower than that in the control group.Conclusions:Using dexamethasone before operation could protec blood vessel endothelial cells;keep the ration of blood PAI and tPA in a state of balance;reduce hyperfibrindysis and postoperative bleeding.The price of dexamethasone is bargain,and it is convenient to obtain,so it can save a lot of money for patients.