【作者】 张飞；

【导师】 周汝元；

【作者基本信息】 安徽医科大学 ， 心血管外科， 2003， 硕士

【摘要】 目的：肺动脉高压是先天性心脏病较常见的严重继发性病变，是影响先心病外科治疗效果的重要因素。本文通过川芎嗪对先心病肺动脉高压围术期血浆中内皮依赖收缩因子及舒张因子变化的研究，探讨川芎嗪对肺血管内皮细胞的保护作用及对肺动脉压的影响。方法：随机选取安徽医科大学第一附属医院心血管外科手术治疗先天性心脏病45例。其中中、重度肺动脉高压30例；肺动脉压正常15例。肺动脉高压中随机分为川芎嗪治疗组(A组，n=15)及对照组(B组，n=15)。实验组手术前1周开始应用川芎嗪至手术后3日，静脉滴注盐酸川芎嗪注射液4-5 mg／kg／d(常州制药厂，40mg／支，生产批号0204002)。肺动脉压正常者为空白对照组(C组，n=15)。对照组及空白组不用川芎嗪，其它治疗用药一致。实验组于用药前，手术前1天，术后24h，术后72h；对照组于术前，术后24h，术后72h；空白组于术前，术后24h抽取静脉血，根据需要行抗凝、离心，分离出血浆，测定血浆中ET-1、NO、cAMP、cGMP含量。实验组于用药前及术中测定肺动脉压。结果：1．实验组及对照组各时点血浆ET-1含量明显高于空白组，NO、cAMP、cGMP含量明显低于空白组，差异均有显著性(P＜0.01)。2．实验组手术前1天肺动脉压较用药前降低，差异有显著性(P＜0.01)。用药前及手术前1天血浆ET-1含量与肺动脉压呈正相关(P＜0.01)。3．实验组手术前1天及术后72h血浆ET-1含量分别低于用药前及术后24h，NO、cAMP、cGMP含量分别高于用药前及术后24h，差异有显著性(P＜0.01)。4．实验组及对照组两组比较：用药前及术后24h血浆中各因子含量无明显变化(P＞0.05)。实验组术后72h血浆ET-1的含量明显下降，cGMP含量明显升高，差异有显著性(P＜0.01)。NO及cAMP含量无明显变化(P＞0.05)。结论：1．先心病肺动脉高压患者，血浆中ET-1含量明显升高，且与肺动脉压呈正相关，而NO、cAMP及cGMP含量明显降低。2．应用川安徽医科大学硕士学位论文芍嗦可明显降低血浆中ET一的含量，增加NO、cAMP及cGMP的含量，提示川芍嗦可降低肺动脉张力及肺动脉压力，减少围术期肺动脉高压危象的发生率，提高手术的成功率。更多还原

【Abstract】 Objective: Pulmonary hypertension(PH) is a fairly common and serious leisure succeed to congenital heart disease .It is a important agent to affect surgical therapeutic efficacy . The article investigates changes of plasma levels of endothelium derived relaxing factor and endothelium derived contracting factor in congenital heart disease associated to pulmonary hypertension in perioperative period to study protect action of on endothelial cells of pneumoangiogram and influence of pulmonary artery pressure. Method: 30 patients finally diagnosed as congenital heart defects associated with moderate and severe PH were randomly divided into the Tetramethylpyrazine group (A group,n=15) and the control group (B group,n=15). 15 patients without PH were called the blank control group (C group,n=15).The patients of A group were injected with Tetramethylpyrazine(5mg/kg) from 1 week before operation to 3 days after operation. Venous blood samples were taken at the following times before medication , 1 day before operation ,24 hours and 72 hours after operation in A group. In B group venous blood samples were taken at preoperative period and 24 hours after operation. Venous blood samples were taken at the following times before operation,24 hours and 72 hours after operation in C group. We measure the pulmonary artery pressure (PAP) before medication and on operation in A group and the concentrations of endothelin-1 (ET-1),nitric oxide (NO),cAMP and cGMP in perioperative period. Results: The PAP of A group on operation were lower than before medication (P<0.01).It has been found that the patients’ PAP is in postitive correlation with plasma ET-1 level. In bothA and B groups the concentration of ET-1 was higher than that in the C group (P< 0.01),but the concentrations of NO,cAMP and cGMP were lower than that in the C group(P<0.01). After treating PH with Tetramethylpyrazine, compared A and B group, plasma ET-1 level decrease and plasma NO,cAMP,cGMP levels increase and has significant difference before operation. Compared 24h with 72h after operation, plasma ET-1 level decrease and plasma cGMP levels increase and has significant difference. But plasma NO and cAMP levels has no transparent changes. Conclusion: Plasma ET-1 level increase obviously and is in positive correlation with PAP , but plasma NO ,cAMP and cGMP levels decrease obviously in congenital heart disease. After treating PH with Tetramethylpyrazine, plasma ET-1 level decrease and plasma NO,cAMP,cGMP levels increase . It prompt that Tetramethylpyrazine can reduce tension and pressure of pulmonary artery and has profitable of decreasing incidence of pulmonary hypertension crisis in perioperative period to rise the success rate of operation.更多还原