食管癌和胃癌患者术后血浆房利钠肽和内皮素浓度升高。

K Itoh, N Goseki, M Endo, F Marumo
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摘要

内皮素-1 (ET-1)和人心房利钠肽(hANP)是血管活性物质。在本研究中,我们试图评估这些物质在严重手术应激患者体内的分泌模式。测定15例食管癌右胸腹切次全食管切除术(EC组)和10例胃癌腹切全胃切除术(GC组)患者血浆ET-1和hANP浓度。EC组术中出血量明显大于GC组,手术时间明显长于GC组。EC组血浆ET-1浓度在手术第1天(第1 POD)显著升高,而GC组血浆ET-1浓度无显著升高。EC组和GC组血浆hANP水平逐渐升高,在第2次POD时达到峰值。EC组在手术当日血浆hANP分泌的增量明显高于GC组,提示ET-1刺激了EC组的hANP。血浆hANP水平在第2次POD时达到峰值,在第5次POD时恢复到术前水平,而PCWP在术后无明显变化。由于PCWP和hANP的术后形态差异不能用循环血容量的变化来解释,因此,hANP的分泌可能受到某些因素的调节,而不是像EC组这样接受重手术应激的患者所经历的左心室压力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Increased plasma atrial natriuretic peptide and endothelin concentrations after surgery in patients with esophageal and gastric cancer.

Endothelin-1 (ET-1) and human atrial natriuretic peptide (hANP) are known as vasoactive substances. In the present study, an attempt was made to evaluate the mode by which these substances are secreted in patients having severe surgical stress. Plasma ET-1 and hANP concentrations were measured in 15 patients with esophageal carcinoma who underwent subtotal esophagectomy via right-thoraco-ventrotomy (EC group) and 10 patients with gastric carcinoma who underwent total gastrectomy via ventrotomy (GC group). The volume of intraoperative hemorrhage was significantly larger and operation time was significantly longer in the EC group than in the GC group. Plasma ET-1 concentration in the EC group increased remarkably on the first operative day (1st POD), whereas that in the GC group did not. Plasma levels of hANP in both the EC and GC groups gradually increased until they peaked on the 2nd POD. The increment of plasma hANP secretion for the EC group was significantly higher than that for the GC group on the day of the operation, suggesting that ET-1 stimulated hANP in the EC group. Plasma hANP levels reached their peak values on the 2nd POD and returned to the preoperation level on the 5th POD, while PCWP did not change significantly after the surgery. Since this discrepancy between the postoperation patterns of PCWP and hANP cannot be explained by changes in the circulating blood volume, hANP secretion may be regulated by certain factors in addition to the left ventricular pressure experienced by patients receiving heavy operation stress, such as those in the EC group.

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