Clinical Significance of Endothelium-derived Vasoactive Substances on Surgical Stress

在相对较小的手术中，血浆内皮素和CNP水平没有明显变化。术中血药浓度变化与手术时间和术中出血量呈正相关。食管手术患者血浆内皮素水平在术后数小时内达到峰值，此后下降，但血浆CNP水平一直升高至术后第7天。心脏手术中动脉血压下降，体外循环诱导后血浆CNP水平明显升高。体外循环、心脏手术后及脓毒症患者血浆CNP水平与外周血管阻力呈显著负相关。休克患者血浆内皮素和CNP水平近似平行显著升高。虽然康复和存活的患者体内的水平有所下降，但死亡的患者体内的水平却居高不下。感染性休克患者血浆CNP水平的升高比血浆内皮素水平的升高更为显著。内毒素休克诱导后，狗的血压下降，血压水平明显升高。肝移植患者供肝再灌注后血浆NOx水平降低。食道手术患者血浆NOx水平无明显变化。PGF2alpha、TxA2和PGD2刺激离体灌注大鼠心脏分泌ANP。高剂量PGE2可使其降低。PGI2对其无影响。高肾上腺髓质素抑制ANP分泌。吸入麻醉药可抑制离体心脏内皮素的基础分泌，但内毒素增加的内皮素分泌不受其影响。

Plasma endothelin and CNP levels did not change significantly during relatively minor surgery. Changes in the levels during surgery had positive correlations with the duration of operation and intraoperative blood loss. In patients undergoing esophageal surgery the plasma endothelin level reached a peak within a few hours after surgery and decreased thereafter, although the plasma CNP level was elevated till postoperative day 7. During heart surgery arterial blood pressure decreased and plasma CNP level increased markedly after cardiopulmonary bypass induction. The plasma CNP level had significant negative correlation with peripheral vascular resistance during cardiopulmonary bypass, after cardiac surgery and in septic patients. In shock patients the plasma endothelin and CNP levels increased markedly approximately in parallel. Although the levels decreased in patients who recovered and survived, those in patients who consequently died sustained high. In septic shock patients the increase of plasma CNP levels was more prominent than that of plasma endothelin levels. After induction of endotoxin shock blood pressure decreased and the levels increased markedly in dogs. Plasma NOx levels decreased after donor liver reperfusion in patients undergoing liver transplantation. In patients undergoing esophageal surgery plasma NOx levels did not change significantly. ANP secretion from isolated perfused rat hearts was stimulated by PGF2alpha, TxA2 and PGD2. High dose of PGE2 decreased it. PGI2 did not influence it. High does of adrenomedullin inhibited ANP secretion. Basal secretion of endothelin from the isolated hearts was inhibited by inhaled anesthetics, although augmented endothelin secretion by endotoxin was not affected by them.