前列腺素E1脂微球载体制剂对体外循环患者肾功能的影响

目的 探讨前列腺素E1脂微球载体制剂(Lipo-PGE1)对体外循环(CPB)患者肾功能的影响.方法 择期拟行心脏瓣膜置换术患者20例,ASAⅡ或Ⅲ级,年龄34～56岁,性别不限,体重48～81 kg,随机分为生理盐水对照组(NS组)和前列腺素E1脂微球载体制剂组(Lipo-PGE1组),每组10例.Lipo-PGE1组于CPB开始至结束持续泵注Lipo-PGE13 ng·kg-1·min-1,预充液Lipo-PGE1浓度为5 ng/ml;NS组给予等容量生理盐水.于肝素化后CPB开始前(T1)、CPB开始30 min(T2)及CPB结束即刻、1、24 h(T3-5)时测定血浆血栓素B2(TXB3)、6-酮-前列腺素F1α(6-Keto-PGF1α)、游离血红蛋白(F-Hb)浓度及血清α1-微球蛋白(α1-MG)、β2-微球蛋白(β2-MG)及半胱氨酸蛋白酶抑制剂C(Cys C)的浓度.结果 与T1时比较,两组T2-4时,TXB2、6-Keto-PG F1α及TXB2/6-Keto-PGF1α、α1-MG、β2-MG浓度升高,T2-5时F-Hb及Cys C浓度明显升高(P<0.05);与NS组比较,Lipo-PGE1组T2～4时6-Keto-PGF1α浓度升高,TXB2、TXB2/6-Keto-PGF1α、α1-MG、β2-MG浓度降低,T2-5时F-Hb及Cys C浓度明显降低(P<0.05).结论 Lipo-PGE1可明显改善体外循环患者的肾功能.

Effects of liposomal prostaglandin E1 on renal function in patients undergoing cardiopulmonary bypass

Objective To investigate the effects of lipnsomal prostnglandin E1 (Lipo-PGE1) on the renal function in patients undergoing cardiopulmonary bypass (CPB) .Methods Twenty ASA Ⅱ or Ⅲ patients of both sexes aged 34-56 yr weighing 48-81 kg scheduled for elective cardiac valve replacement with CPB were randomly divided into 2 groups (n = 10 each): normal saline group (group NS) and Lipo-PGE1 group. In group Lipo-PGE1, Lipo-PGE1 was infused at 3 ng·kg-1·min-1 from the initiation of CPB to the end of CPB, and then added into the priming solution of the extracorporeal circulation machine with its concentration set at 5 ng/ml. In group NS, the equal volume of normal saline was administered instead of Lipo-PGE1 . The concentrations of thromboxane B2 ( TXB2 ), 6-keto-prostnglandin F1α ( 6-Keto-PGF1α ), and free hemoglobin ( F-Hb ) in plasma, and α1-microgipbulin (α1-MG), β2-micmglobulin (β2-MG) and Cystatin C (Cys C) in serum were measured after heparinization and before CPB (T1), at 30 min of CPB (T2) and at 0, 1 and 24 h after termination of CPB (T3-5). Results Compared to T1, the concentrations of TXB2, 6-Keto-PGF1α, α1-MG and β2-MG and TXB2/6-Keto-PGF1α ratio at T2-4, and the concentrations of F-Hb and Cystatin C at T2-5 were significantly increased in both groups ( P < 0.05). The concentration of 6-Keto-PGF1α at T2-4 was significantly higher, and concentrations of TXB2, α1-MG and β2-MG and TXB2/6-Keto-PGF1α ratio at T2-4 and concentrations of F-Hb and Cys C at T2-5 were significantly lower in group Lipo-PGE1 than in group NS ( P < 0.05). Conclusion Lipo-PGE1 can obviously improve the renal function in patients undergoing CPB.