甲泼尼松龙对体外循环肺内血小板聚集、血栓素生成的抑制作用及其意义

探讨大剂量甲泼尼松龙（ＭＰＳＳ）对肺再灌注早期血小板聚集、血栓素生成的抑制作用。方法将３０例体外循环心脏手术患者随机分成对照组与ＭＰＳＳ用药组，各１５例。用药组于体外循环前静注ＭＰＳＳ１５ｍｇ／ｋｇ体重。３０例患者分别于体外循环前、复跳后１０、４５分钟、２小时抽左右心房血，检测血小板数、ＴＸＢ２及６－ｋｅｔｏ－ＰＧＦ１αｏ。结果对照组复跳后各时相左房血血小板数明显比右房者低（Ｐ＜０．０５），左房血ＴＸＢ２含量明显比右房者高（Ｐ＜０．０１）；而用药组复跳后左、右房血血小板数、ＴＸＢ２差异无显著意义。用药组并能明显降低复跳后ＴＸＢ２／６－ｋｅｔｏ－ＰＧＦ１α比值（Ｐ＜０．０５～０．０１）。结论大剂量ＭＰＳＳ对肺再灌注早期血小板聚集有明显抑制作用，减少肺内血栓素生成，降低血栓素／前列环素比值，起到预防或减少灌注肺发生的作用。

Inhibitory effect of methylprednisolone on platelet aggregation and thromboxane synthesis in the lung following cardiopulmonary bypass and clinical implication

Objective To obtain the theoretical basis of clinical prevention and treatment of lung injuryfollowing cardiopulmonary bypass (CPB), the inhibitory effect of large dose of methylprednisolone on plateletaggregation and thromboxane synthesis in the early phase of the pulmonary reperfusion was investigated.Method Thirty patients undergoing open heart surgery with CPB were equally divided into a control groupand a MPSS group at random. In MPSS group, patients were given MPSS 15 mg/kg tv before CPB. Bloodsamples of 30 patients were taken from the left and right atrium before CPB and 10 min, 45 min, 2 h after release of the aortic cross-clamp for determination of platelet count, TXB2 and 6-keto-PGF Result Theplatelets in the left atrium were significantly lower than those in the right atrium (P<0. 05), and the level ofTXB2 in the left atrium was significantly higher than that in the right atrium (P<0. 01), in the early phase ofthe pulmonary reper fusion in control group. But there was no significant difference in both platelet and TXB2in MPSS group. The ratio of TXB2/6-keto-PGF was significantly decreased in the early phase of the pulmonary reper fusion in MPSS group, as compared with that in the control group (P<0.05). ConclusionHigh dose of MPSS can significantly decrease the platelet aggregation, the thromboxane production and the ratio of thromboxane-prostacyclin in the early phase of the pulmonary reperfusion, and so can prevent for Iunginjury.