前列腺素E1脂微球载体制剂对围体外循环期患者肾功能影响的观察与研究
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摘要
目的：观察前列腺素E_1脂微球载体制剂(liposomal prostaglandin E_1，lipo-PGE_1)对心脏瓣膜置换术患者围体外循环(cardiopulmonary bypass，CPB)期肾功能的影响并探讨其可能的机制。
方法：选择20例择期CPB下行瓣膜置换术的患者，随机分为观察组(Lipo-PGE_1组，L组)及对照组(C组)两组，每组10例。L组于麻醉诱导后至CPB结束匀速泵入Lipo-PGE_1，速度为3ng／(kg·min)，预充液中加入5ng／ml；C组用相同容量的生理盐水作为对照，用药方法同L组。分别于肝素化后(T_1)、CPB30min(T_2)、停CPB即刻(T_3)、停CPB后1H(T_4)及停CPB24H(T_5)五个时点采集动脉血。测定血清中a_1-微球蛋白(a_1-MG)、和β_2-微球蛋白(β_2-MG)水平及血浆中血栓素B_2(TXB_2)和6-酮-前列腺素F_(1a)(6-keto-PGF_(1a))水平并计算TXB_2／6-keto-PGF_(1a)；同时记录患者术前血肌酐(Cr)及尿素氮(BUN)水平，手术时间、CPB时间、主动脉阻断时间及CPB转流速度、灌注压力，术中速尿用量及入液量，术中及术后24H尿量。
结果：(1)两组患者一般情况无统计学差异。(2)血清中a_1-MG、β_2-MG水平：T_2后开始升高，T_3时达峰值，T_5恢复至术前水平。各时点L组均明显低于C组(P＜0.01)。(3)血浆TXB_2、6-keto-PGF_(1a)水平及TXB_2／6-keto-PGF_(1a)：T_2后均升高，T_3时达峰值，T_5恢复至术前水平。T_2～T_4时点，L组TXB_2显著低于C组(P＜0.05)，6-keto-PGF_(1a)则显著高于C组(P＜0.01)。二者比值则于T_2始升高，T_3达峰值时。T_4时L组已恢复术前水平，C组T_5方恢复。该比值在各时点L组均低于C组(P＜0.01)。(4)CPB中及CPB后24H尿量：CPB中及CPB后24H，L组尿量均高于C组，但CPB后24H无统计学意义(P＞0.05)。
Objective: To study the effect of Iiposomal Prostaglandin E_1(Lipo-PGE_1) on kidney function during cardiopulmonary bypass(CPB) in cardiac valve replacement.
Methods: 20 patients scheduled for cardiac valve replacement undergoing CPB were randomized into two groups: group L (n=10) and group C(n=10). patients in group L were administered 3ng/(kg· min) of Lipo-PGE_1 and some other Lipo-PGE_1(5ng/ml) was added to the priming solution of the extracorporeal machine. patients in group C were only administered the same volume of normal saline in the same way. a_1-microglpbulin(a_1-MG)、 β_2- microglpbulin (β_2-MG)、 Thromboxane B_2(TXB_2) and 6-keto-Prostaglandin F_(1a)(6-keto-PGF_(1a)) were measured at pre-CPB(T_1)、 30 min of CPB(T_2)、 the end of CPB(T_3)、 1H after CPB(T_4) and 24H after CPB(T_5). At the same time, the TXB_2/6-keto-PGF_(1a) was calculated. The creatinine and urea nitrogen of pre-operation in blood, the frusemide used and the volume of liquid into patients' body in operation, and the volume of urine in operation and 24H after operation were observed.
Result: (1) There were no signification differences between the two groups in ecumenical things. (2) a_1-MG and β_2-MG: a_1-MG and β_2-MG was higher than baseline at T_2～T_4 in both group. The highest were at T_3 (P<0.01). At same time a_1-MG and β_2-MG in group L were lower than in group C(P<0.01). (3) TXB_2、 6-keto-PGF_(1a) and TXB_2/6-keto-PGF_(1a): TXB_2、 6-keto-PGF_(1a) were significantly higher than the baseline at T_2～T_4, the highest was at T_3(P<0.01). TXB_2 at same time in group L was lower than in group C (P<0.05). 6-keto-PGF_(1a) at same time in group L was higher than in group C (P<0.01). TXB_2/6-keto-PGF_(1a) was higher than the baseline from T_2, and the highest was at T_3. In group L it decline to the baseline at T_4 and this phenomena can be seen at T_5 in group C. And TXB_2/6-keto-PGF_(1a) was lower in group
方法：选择20例择期CPB下行瓣膜置换术的患者，随机分为观察组(Lipo-PGE_1组，L组)及对照组(C组)两组，每组10例。L组于麻醉诱导后至CPB结束匀速泵入Lipo-PGE_1，速度为3ng／(kg·min)，预充液中加入5ng／ml；C组用相同容量的生理盐水作为对照，用药方法同L组。分别于肝素化后(T_1)、CPB30min(T_2)、停CPB即刻(T_3)、停CPB后1H(T_4)及停CPB24H(T_5)五个时点采集动脉血。测定血清中a_1-微球蛋白(a_1-MG)、和β_2-微球蛋白(β_2-MG)水平及血浆中血栓素B_2(TXB_2)和6-酮-前列腺素F_(1a)(6-keto-PGF_(1a))水平并计算TXB_2／6-keto-PGF_(1a)；同时记录患者术前血肌酐(Cr)及尿素氮(BUN)水平，手术时间、CPB时间、主动脉阻断时间及CPB转流速度、灌注压力，术中速尿用量及入液量，术中及术后24H尿量。
结果：(1)两组患者一般情况无统计学差异。(2)血清中a_1-MG、β_2-MG水平：T_2后开始升高，T_3时达峰值，T_5恢复至术前水平。各时点L组均明显低于C组(P＜0.01)。(3)血浆TXB_2、6-keto-PGF_(1a)水平及TXB_2／6-keto-PGF_(1a)：T_2后均升高，T_3时达峰值，T_5恢复至术前水平。T_2～T_4时点，L组TXB_2显著低于C组(P＜0.05)，6-keto-PGF_(1a)则显著高于C组(P＜0.01)。二者比值则于T_2始升高，T_3达峰值时。T_4时L组已恢复术前水平，C组T_5方恢复。该比值在各时点L组均低于C组(P＜0.01)。(4)CPB中及CPB后24H尿量：CPB中及CPB后24H，L组尿量均高于C组，但CPB后24H无统计学意义(P＞0.05)。
Objective: To study the effect of Iiposomal Prostaglandin E_1(Lipo-PGE_1) on kidney function during cardiopulmonary bypass(CPB) in cardiac valve replacement.
Methods: 20 patients scheduled for cardiac valve replacement undergoing CPB were randomized into two groups: group L (n=10) and group C(n=10). patients in group L were administered 3ng/(kg· min) of Lipo-PGE_1 and some other Lipo-PGE_1(5ng/ml) was added to the priming solution of the extracorporeal machine. patients in group C were only administered the same volume of normal saline in the same way. a_1-microglpbulin(a_1-MG)、 β_2- microglpbulin (β_2-MG)、 Thromboxane B_2(TXB_2) and 6-keto-Prostaglandin F_(1a)(6-keto-PGF_(1a)) were measured at pre-CPB(T_1)、 30 min of CPB(T_2)、 the end of CPB(T_3)、 1H after CPB(T_4) and 24H after CPB(T_5). At the same time, the TXB_2/6-keto-PGF_(1a) was calculated. The creatinine and urea nitrogen of pre-operation in blood, the frusemide used and the volume of liquid into patients' body in operation, and the volume of urine in operation and 24H after operation were observed.
Result: (1) There were no signification differences between the two groups in ecumenical things. (2) a_1-MG and β_2-MG: a_1-MG and β_2-MG was higher than baseline at T_2～T_4 in both group. The highest were at T_3 (P<0.01). At same time a_1-MG and β_2-MG in group L were lower than in group C(P<0.01). (3) TXB_2、 6-keto-PGF_(1a) and TXB_2/6-keto-PGF_(1a): TXB_2、 6-keto-PGF_(1a) were significantly higher than the baseline at T_2～T_4, the highest was at T_3(P<0.01). TXB_2 at same time in group L was lower than in group C (P<0.05). 6-keto-PGF_(1a) at same time in group L was higher than in group C (P<0.01). TXB_2/6-keto-PGF_(1a) was higher than the baseline from T_2, and the highest was at T_3. In group L it decline to the baseline at T_4 and this phenomena can be seen at T_5 in group C. And TXB_2/6-keto-PGF_(1a) was lower in group
引文
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