【作者】 张晓霞；

【导师】 潘晓军；

【作者基本信息】 山东大学 ， 麻醉学， 2006， 硕士

【摘要】 目的：观察前列腺素E₁脂微球载体制剂（liposomal prostaglandin E₁，lipo-PGE₁）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-PGE₁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-PGE₁，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（T₁）、CPB30min（T₂）、停CPB即刻（T₃）、停CPB后1H（T₄）及停CPB24H（T₅）五个时点采集动脉血。测定血清中a₁-微球蛋白（a₁-MG）、和β₂-微球蛋白（β₂-MG）水平及血浆中血栓素B₂（TXB₂）和6-酮-前列腺素F_1a(6-keto-PGF_1a)水平并计算TXB₂／6-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a₁-MG、β₂-MG水平：T₂后开始升高，T₃时达峰值，T₅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TXB₂、6-keto-PGF_1a水平及TXB₂／6-keto-PGF_1a：T₂后均升高，T₃时达峰值，T₅恢复至术前水平。T₂～T₄时点，L组TXB₂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T₂始升高，T₃达峰值时。T₄时L组已恢复术前水平，C组T₅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）。更多还原

【Abstract】 Objective: To study the effect of Iiposomal Prostaglandin E₁（Lipo-PGE₁） 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-PGE₁ and some other Lipo-PGE₁（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. a₁-microglpbulin（a₁-MG）、 β₂- microglpbulin （β₂-MG）、 Thromboxane B₂（TXB₂） and 6-keto-Prostaglandin F_1a(6-keto-PGF_1a) were measured at pre-CPB（T₁）、 30 min of CPB（T₂）、 the end of CPB（T₃）、 1H after CPB（T₄） and 24H after CPB（T₅）. At the same time, the TXB₂/6-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） a₁-MG and β₂-MG: a₁-MG and β₂-MG was higher than baseline at T₂～T₄ in both group. The highest were at T₃ （P<0.01）. At same time a₁-MG and β₂-MG in group L were lower than in group C（P<0.01）. （3） TXB₂、 6-keto-PGF_1a and TXB₂/6-keto-PGF_1a: TXB₂、 6-keto-PGF_1a were significantly higher than the baseline at T₂～T₄, the highest was at T₃（P<0.01）. TXB₂ 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）. TXB₂/6-keto-PGF_1a was higher than the baseline from T₂, and the highest was at T₃. In group L it decline to the baseline at T₄ and this phenomena can be seen at T₅ in group C. And TXB₂/6-keto-PGF_1a was lower in group更多还原