【摘要】 目的　探讨体外循环术后鱼精蛋白中和肝素对肺循环一氧化氮含量变化及体、肺循环血流动力学的影响。方法　测定 2 4例体外循环下行房间隔缺损、室间隔缺损修补术的儿童患者注射鱼精蛋白前后左、右心房血NO的终代谢产物亚硝基(NO2 -)和硝基 (NO3 -)含量。测定注射前后心率、平均动脉压、平均肺动脉压、左房压和中心静脉压。结果　注射鱼精蛋白前右房和左房NO2 -含量分别为 (3 85± 0 73) μmol/L和 (4 12± 0 85 ) μmol/L(P >0 0 5 ) ,注射后左房NO2 -含量 [(4 5 7± 0 90 )μmol/L]明显高于右房 [(4 0± 0 81) μmol/L](P <0 0 5 ) ,NO3 -含量呈类似的改变 (P <0 0 5 )。注射鱼精蛋白后平均动脉压和中心静脉压较注射前显著性降低 (P <0 0 5 ,P <0 0 1) ,其他血流动力学参数无显著性变化。结论　鱼精蛋白可以刺激体、肺循环系统合成释放一氧化氮 ,前者导致动脉压下降 ,后者可预防注射鱼精蛋白后可能出现的肺血管收缩反应更多还原

【Abstract】 Objective To investgate the effect of protamine neutralizing heparin on nitric oxide changes in the pulmonary system and its effects on the systemic and pulmonary hemodynamics Method Twenty-four patients atrial heart septal defect (ASD)or ventricular heart septal defect (VSD) undergoing elective cardiopulmonary bypass surgery were studied Nitrite and nitrate levels as endmetabolites of NO were measured in blood samples before and after protamine administration Heart rate,mean arterial pressure,mean pulmonary arterial pressure,left atrial pressure and central venous pressure were detected Results Nitrite levels were(3 85±0 73)μmol/L in the right atrium and (4 12±0 85)μmol/L in the left atrium before protamine infusion and increased to (4 0±0 81) μmol/L and (4 57±0 90)μmol/L in the right and left atrium respectively after infusion The changes were statistically significant ( P <0 05) The changes of nitrate level showed similar to those of nitrite Mean aterial pressure and central venous pressure decreased significantly after protamine infusion compared to those before infusion ( P <0 05, P <0 01,respectively) The changes of other hemodynamic parameters were not significant Conclusion Prolamine stimulates NO production in both pulmonary and systemic arteries The increase of NO production pre-vents the pulmonary circulation from possible vasoconstriction,while the increase in systemic arteries causes systemic hypotension更多还原