体外循环对肺表面活性物质的影响

目的探讨体外循环对肺表面活性物质的影响。方法分别采用Ｂａｒｔｌｅｔ法、Ｍａｓｏｎ法、改良Ｌｏｗｒｙ法、抗原抗体斑点杂交法测定１２例非体外循环治疗患者和１９例经体外循环治疗患者气道吸出物中总磷脂、饱和卵磷脂、总蛋白、肺表面活性物质特异蛋白－Ａ（ＳＰ－Ａ）的含量。结果体外循环术后，饱和卵磷脂／总磷脂比值从４８％降至３４％（ｔ＝２．７３７，Ｐ＜０．０５）；饱和卵磷脂／总蛋白比值从６４降至３３ｍｇ／ｇ（ｔ＝３．０１１，Ｐ＜０．０１）；ＳＰ－Ａ／总蛋白比值从２３降至１１ｍｇ／ｇ（ｔ＝２．９８７，Ｐ＜０．０１）。而非体外循环组患者上述参数指标无明显变化。结论证实体外循环可明显降低肺表面活性物质的活性，为进一步应用外源性ＰＳ治疗体外循环术后的呼吸功能不全提供理论依据。

The effects of cardiopulmonary by pass on pulmonary surfactant activity

Objective To study the effects of cardiopulmonary by pass(CPB) on pulmonary surfactant(PS) activity. Methods In 12 children with patent ductus arteriosus(PDA) and 19 patients with ventricular septal defect(VSD), saturated phosphatidylcholine(SatPC),total phospholipids(TPL),total protein(TP) and surfactant protein A(SP A) in sequential airway aspirates before and after operation were determined. Tetroxide osmium digestion and neutral alumina column chromatography were used for SatPC,and a modified immunoblot method with a rabbit anti human SP A polyclonal antibody for SP A measurment. Results In 19 VSD patients with CPB, SatPC/TPL was significantly decreased from 48% to 34%( t =2.737, P <0.05), SatPC/TP decreased from 64 to 33 mg/g( t =3.011, P < 0.01 ), and SP A from 23 to 11mg/g( t =2.987, P <0.01). In 12 patients without CPB, SatPC/TPL, SatPC/TP, SP A/TP levels were not changed. Conclusion CPB significantly reduces pulmonary surfactant activity.