CAJ | 학술논문

目的观察并探讨重组入脑利钠肽(recombinant human brain natriuretic peptide,rhBNP)对体外循环(CPB)心脏瓣膜置换术患者血浆内毒素及全身炎性反应的影响及作用机制.方法心脏瓣膜置换术患者32例,随机分为对照组和治疗组.治疗组于主动脉阻断前5 min匀速静脉注射rhBNP负荷量1.5μg·kg-1·min-1,随后以0.0075 μg·kg-1·min-1维持量静脉注射24h;对照组则用同样方法输入等容量0.9％氯化钠.分别于术前(T1)、CPB结束时(T2)、结束后4h(T3)、8 h(T4)、24 h(T5)测定血浆内皮素( endothelin,ET)-1、血浆二胺氧化酶(diamine oxidase,DAO)、内毒素(lipopolysaccharide,LPS)及肿瘤坏死因子(TNF)-α水平.结果T1时两组患者血浆ET-1、DAO、LPS、TNF-α水平比较差异无统计学意义(P＞0.05)；T2、T3、T4、T5各时点两组患者血浆DAO、LPS、TNF-α水平显著高于T1时水平(P＜0.01),治疗组患者在T5时血浆ET-1水平与T1时相比差异无统计学意义(P=0.24).CPB结束后治疗组ET-1、DAO、LPS、TNF-α水平均显著低于同一时间点的对照组水平(P＜0.01).血浆ET-1与DAO水平呈正相关(r=0.51,P＜0.01),血浆DAO与LPS水平呈正相关(r=0.77,P＜0.01),血浆LPS与TNF-α水平呈正相关(r=0.48,P＜0.01).结论重组人脑利钠肽可能通过抑制体外循环过程中ET-1的释放,减轻胃肠道血管收缩,改善胃肠黏膜灌注和氧合,保护胃肠黏膜屏障功能,阻止肠源性内毒素移位,降低血浆内毒素水平,减轻全身炎性反应.
목적 관찰병탐토중조입뇌리납태(recombinant human brain natriuretic peptide,rhBNP)대체외순배(CPB)심장판막치환술환자혈장내독소급전신염성반응적영향급작용궤제.방법 심장판막치환술환자32례,수궤분위대조조화치료조.치료조우주동맥조단전5 min균속정맥주사rhBNP부하량1.5μg·kg-1·min-1,수후이0.0075 μg·kg-1·min-1유지량정맥주사24h;대조조칙용동양방법수입등용량0.9％록화납.분별우술전(T1)、CPB결속시(T2)、결속후4h(T3)、8 h(T4)、24 h(T5)측정혈장내피소( endothelin,ET)-1、혈장이알양화매(diamine oxidase,DAO)、내독소(lipopolysaccharide,LPS)급종류배사인자(TNF)-α수평.결과T1시량조환자혈장ET-1、DAO、LPS、TNF-α수평비교차이무통계학의의(P＞0.05)；T2、T3、T4、T5각시점량조환자혈장DAO、LPS、TNF-α수평현저고우T1시수평(P＜0.01),치료조환자재T5시혈장ET-1수평여T1시상비차이무통계학의의(P=0.24).CPB결속후치료조ET-1、DAO、LPS、TNF-α수평균현저저우동일시간점적대조조수평(P＜0.01).혈장ET-1여DAO수평정정상관(r=0.51,P＜0.01),혈장DAO여LPS수평정정상관(r=0.77,P＜0.01),혈장LPS여TNF-α수평정정상관(r=0.48,P＜0.01).결론 중조인뇌리납태가능통과억제체외순배과정중ET-1적석방,감경위장도혈관수축,개선위장점막관주화양합,보호위장점막병장공능,조지장원성내독소이위,강저혈장내독소수평,감경전신염성반응.
Objective To observe the effects of recombinant human brain natriuretic peptide on the plasma endotoxin and systemic inflammatory response in patients undergoing cardiac valve replacement surgery during cardiopulmonary bypass (CPB) and to explore its mechanism.Methods 32 patients with elective heart valve replacement surgery during cardiopulmonary bypass were divided into a control group and a treatment group randomly.The patients of treatment group were recievel rhBN (1.5 μg · kg-1 · min-1 bolus intravenous injection before aortic cross-clamping followed by 0.0075 μg · kg-1 · min-1 for 24 hours),while the patients of control group received the same volume of 0.9％ sodium chloride.The plasma levels of endothelin -1 ( ET-1 ),diamine oxidase(DAO),lipopolysaccharide ( LPS),tumor necrosis factor-α (TNF-α) before skin incision ( T1 ),the end of CPB ( T2 ),4 h after the end of CPB ( T3 ),8 h after the end of CPB (T4),24h after the end of CPB (T5) respectively.Results Before skin incision ( T1 ),plasma ET-1,DAO,LPS,TNF-α of two group patients showed no significant difference ( P ＞ 0.05 ) ; At each time point after the end of CPB ( T2,T3,T4,T5 ) Plasma DAO,LPS,TNF-α levels of two groups patients were significantly higher than before skin incision ( T1 ) levels ( P ＜ 0.01 ).There was no significant difference of the plasma levels of ET-1 between T5 and T1 in treatment group patients ( P =0.24).At each time point after the end of CPB ( T2,T3,T4,T5 ),treatment group patients'plasma ET-1,DAO,LPS,TNF-α levels were significantly lower than the control group respectively (P ＜0.01 ).The increase in blood ET-1 was highly positive correlated with the increase in blood DAO (r=0.51,P ＜0.01 ).The increase in blood DAO was highly positive correlated with the increase in blood LPS (r =0.77,P ＜ 0.01 ).The increase in blood LPS was significantly positive correlated with the increase in blood TNF-α ( r =0.48,P ＜0.01 ).Conclusion Recombinant human brain natriuretic peptide can reduce gastrointestinal vasoconstriction,improve gastrointestinal mucosal perfusion and oxygenation,protect the gastrointestinal mucosal barrier function,preventing intestinal endotoxemia Shift,reduce plasma endotoxin levels and reduce systemic inflammatory response by inhibiting the release of ET-1 during CPB.