摘要
目的 探讨心瓣膜病合并肺高压 ( PH)病人及瓣膜置换术中血浆内皮素 ( ET)和一氧化氮 ( NO)水平变化及其病理生理作用。方法 2 1例病人 ( 2 0～ 5 4岁 )麻醉诱导后 ,采用 Swan- Ganz导管技术测定平均肺动脉压 ( m PAP) ,分成 3组 :即中、重度肺高压 ( m PAP>3 0 mm Hg肺动脉收缩压与体动脉收缩压比值 :Pp/Ps>0 .4 5 )组 ( M&S- PH n=8) ;轻度肺高压 ( m PAP>2 0 mm Hg Pp/Ps>0 .2 5 )组 ( mild- PH n=7)及无肺高压 ( m PAP≤ 2 0 mm Hg Pp/Ps≤ 2 .5 )组 ( no- PH n=6)。经 Swanz- Ganz导管采右房、肺动脉血 ,转流中采机器静脉血。应用放射免疫分析法检测血浆 ET浓度 ,镀铜镉还原法测定血清 NO2 - /NO- 3 (反映 NO水平 )浓度。结果 两组伴肺高压病人麻醉诱导后 ,在肺动脉血 ET和 NO浓度明显高于右房血 ET和 NO浓度 ;M&S- PH组右房血 ET浓度 ,CPB后 3 0分钟时明显高于 no-PH( P<0 .0 5 ) ,CPB后 60分钟时明显高于 Mild- PH和 no- PH组 (分别 P<0 .0 1) ,且较麻醉诱导后显著增高 ( P<0 .0 5 )。伴肺高压两组病人 CPB前后 NO浓度无明显变化 ,no- PH组 CPB后 3 0分钟时较麻醉诱导后明显降低 ( P<0 .0 5 )。CPB后 3 0、60分钟时 ,右房血 ET与 NO比值 ( ET/NO)较麻醉诱导后显著增加 (分别 P<0 .0 5 ,n=2 1)
Objective This investigation was designed to evaluate the pathophysiological sig nificance of endothelin (ET) and nitric oxide (NO) in patients with valve heart desease associated with pulmonary hypertesion (PH) and undergoing valve replacement Methods Twenty patients,aged 20 to 54 years,whose mean pulmonary arterial pressures (mPAP) were obtained from Swan Ganz catheter monitoring after induction of anesthesia,were divided into three groups:moderate or severe PH (M or S PH) (mPAP>30mmHg,pulmonary to systemic arterial systolic pressure ratio:Pp/Ps>0 45,n=8),mild PH (mPAP>20mmHg,Pp/Ps>0 25,n=7),and non PH (mРАР≤20mmHg,Рр/Ps≤0 25,n=6) group Blood samples were obtained from right atrium (RA),small pulmonary artry (PA) and venous line of CPB machine ET level was determined by using radioim munoassay NO - 2/NO - 3 (reflecting NO level) was determined by copper coated with cadmium reduc tion method Results ET and NO concentrations in PA were significantly higher than that in RA in both PH groups after the induction of anesthesia ET concentration of RA in the group with M or S PH was higher than that in the group with non PH (P<0 05) 30 min after CPB and was higher than that in the groups with mild PH and non PH (P<0 01) 60 min after CPB and increased significantly as compared with that after induction of anesthesia (P<0 05) NO concentration did not change significantly in the groups with M or S PH and mild PH before and after CPB NO level in the group with non PH 30 min after CPB decreased significantly as compared with that after induction of anes thesia ET to NO ratio (ET/NO) of the RA blood significantly increased 30 and 60 min after CPB ascompared with that after induction of anesthesia (P<0 05) There was a positive correlation between ET/NO of RA and Pp/Ps after induction of anesthesia (r=0 689,P<0 01) Conclusion The imbalance between increased ET level and decreased or constant NO level after CPB in the patient with PH can contribute to dominant effects of ET,which may worsen lung injure
出处
《中华麻醉学杂志》
CSCD
北大核心
1999年第10期589-592,共4页
Chinese Journal of Anesthesiology
关键词
心脏瓣膜疾病
肺性高血压
麻醉
一氧化氮
Heart valve diseases
Hypertension
pulmonary
Nitric oxide
Endothelins
