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Clinical Significance of Endothelium-derived Vasoactive Substances on Surgical Stress

内皮源性血管活性物质对手术应激的临床意义

基本信息

批准号：
07671656
负责人：
SHIRAKAMI Gotaro
金额：
$ 1.54万
依托单位：
Kyoto University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
1995
资助国家：
日本
起止时间：
1995 至 1997
项目状态：
已结题

项目摘要

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.

在相对较小的手术期间，血浆内皮素和CNP水平没有明显变化。术中血药浓度的变化与手术时间和术中出血量呈正相关。食道手术患者血浆内皮素水平在术后数小时内达高峰，之后下降，但血浆CNP水平一直升高至术后第7天。心脏手术期间，体外循环后动脉血压明显下降，血浆CNP水平显著升高。体外循环期间、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。在休克患者中，血浆内皮素和CNP水平几乎平行地显着升高。虽然在康复和存活的患者中，这一水平有所下降，但在随后死亡的患者中，这一水平仍然居高不下。感染性休克患者血浆CNP水平升高较ET水平升高更为明显。内毒素休克后，犬血压明显下降，血浆内毒素水平明显升高。肝移植患者供肝再灌流后血浆NOx水平降低。在接受食道手术的患者中，血浆NOx水平没有明显变化。PGF2α、TXA2和PGD2可刺激大鼠心脏ANP的分泌。高剂量的前列腺素E_2可使其降低。PGI2对其无影响。大剂量肾上腺髓质素可抑制ANP的分泌。吸入麻醉剂可抑制离体心的内皮素基础分泌，但不影响内毒素对其分泌的促进作用。