摘要
目的:探讨腹部手术患者血浆内皮素(ET)、一氧化氮(NO)、前列环素(PG)I2和血栓素A2(TXA2)的变化。方法:腹部手术患者30例中24例胆囊炎胆石症,2例消化性溃疡,4例门静脉高压症。住院后1~3 d(T1),麻醉后手术开始前(T2)和术后第1天(T3)、第3天(T4)、第5天(T5)5个不同的时间点测定血浆ET-1水平,NO^-_2、NO^-_3、6-酮-PGF1α(6-keto-PGF1α)和血栓素B2(TXB2),后3者是NO、PGI2、TXA2的稳定代谢产物。结果:麻醉和手术后ET-1显著增加[T1=(69.2±10.7)ng·L^(-1)对T2=(82.4±14.7)ng·L^(-1)与T3=(96.6±22.8)ng·L^(-1),P<0.05]。手术后TXB2水平显著升高[T2=(67.5±52.7)ng·L^(-1)对T3=(157.6±21.8)ng·L^(-1),P<0.05]。术前NO水平明显高于手术后[T1=(2 575±50)μg·L^(-1)对T2=(1 922±44)μg·L^(-1)与T3=(1 692±39)μg·L^(-1),P<0.05]。6-keto-PGF1α手术前的水平均明显高于麻醉和术后[T1=(180.5±17.8)ng·L^(-1)对T2=(132.1±32.6)ng·L^(-1)与T3=(110.9±31.9)ng·L^(-1),P<0.05]。结论:手术后血管收缩因子(ET及TXA2)水平明显升高,而血管舒张因子(NO、PGI2)水平明显下降。手术后血管活性因子失衡导致高凝状态可能在并发症如深静脉血栓形成的病理学中发挥作用。
Objective： To investigate the changes in plasma levels of endothelin（ET）, nitric oxide（NO）, prostacyclin （PG） I2 and thromboxane A2 （TXA2） in patients undergoing abdominal operation. Methods： Thirty cases of abdominal surgery（14 males, 16 females; mean age（48 ± 11） years, ranging from 24 to 70） were prospectively recruited： twenty-four cases of cholelithiasis and cholecystitis, 2 cases of peptic ulcer and 4 cases of portal vein hypertension. At five different time points （1-3 days after hospitalization （T1）, at surgery beginning, after anesthesia （T2） and at first （ T3 ）, third （ T4 ） and fifth day （ T5 ） after surgery） , plasma levels of ET- 1, NO2 , NO3- , 6- keto- PGF1a and thromb0xane B2（TXB23 _ the latter three being stable metabolites of NO, PGI2 and TXA2 respectively,were measured. Results： ET-1 levels significantly increased after anesthesia and surgery （T1 = （69.2± 10.7 ） ng ·L -1 vs T2 = （ 82.4± 14.7 ） ng ·L -1 vs T3 = （96.6 ± 22.8 ） ng ·L -1 , P 〈 0.05 ）. TXB2 levels before surgery were significantly lower than after surgery （32 = （67.5 ± 52.7 ） ng ·L -1 vs 33 = （ 157.6 ± 21. g ） ng ·L -1 , P 〈 0.05 ）. Pre-surgery NO levels were significantly higher than after surgery （T1 = （2 575 ± 50） μg ·L -1 vs T2 = （1 922 ± 44）μg ·L -1 vs T3 = （ 1 692 ±39 ） μg ·L -1 , P 〈 0.05 ）. Presurgery levels of 6- keto- PGF1 a were significantly higher than those after anesthesia and surgery（T1 = （180.5 ± 17.8） ng ·L -1 vs T2 = （132.1 ±32.6） ng ·L -1 vs T3 = （ 110.9 ± 31.9 ） ng ·L -1 , P 〈 0.05 ）. Conclusion： Levels of vasoconstrictive factors （ ET and TXA2） significantly increased after surgery, while vasodilatory factors （NO and PGI2 ） significantly decreased after operation. Imbalance in vasoactive factors encourages hypercoagulability and then may play a role in the pathobiology of post-surgery complications, such as deep venous thrombosis.
出处
《现代医学》
2015年第11期1331-1336,共6页
Modern Medical Journal
基金
河北省2011年医学科学研究重点课题项目(20110385)
关键词
腹部手术
前列环素
血栓素A2
内皮素
一氧化氮
深静脉血栓
血栓状态
abdominal surgery
prostacyclin
thromboxane A2
endothelin
nitric oxide
deep venous thrombosis
thrombotic state
