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Kokyu to Junkan Volume 37, Issue 1 （January 1989）

呼吸と循環 37巻1号（1989年1月発行）

Japanese English

研究

心臓手術時の血清Pancreatic secretory trypsin inhibitor（PSTI）について Changes in serum pancreatic secretory trypsin inhibitor(PSTI) during and after heart surgery 安藤富男 ¹ , 土居久栄 ¹ , 北村俊治 ¹ , 鈴木宏昌 ¹ , 奥津芳人 ¹ Tomio Andoh ¹ , Hisae Doi ¹ , Shunji Kitamura ¹ , Hiromasa Suzuki ¹ , Yoshito Okutsu ¹ ¹横浜市立大学医学部麻酔科学教室 ¹Department of Anesthesiology, Yokohama City University School of Medicine pp.71-76

発行日 1989年1月15日 Published Date 1989/1/15

DOI https://doi.org/10.11477/mf.1404205406

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Abstract 文献概要
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　Pancreatic secretory trypsin inhibitor （以下PSTIとする）は主に膵液中に分泌されるプロテアーゼインヒビターであるが，膵疾患以外に外科的侵襲や重症外傷などによって血清中に上昇することが指摘され，生体への侵襲に反応して血中に増加する急性相反応物質の一種であろうと推測されている^1）。術後の血清PSTIは侵襲の大きな手術ほどより大きく増加し，食道や上腹部手術後には術後3日をピークに数倍以上に上昇すると報告されているが^1,2），心臓手術後については報告がない。

　そこで今回われわれは，心臓手術の侵襲の大きさを示す指標になるのではないかと考え，人工心肺を用いる心臓手術時と人工心肺を用いないエーテル単純低体温麻酔下の開心術時の血清PSTIの変動を調べた。さらに，これと関連すると思われるいくつかの因子について血清PSTIとの関係を検討したので報告する。

Serum pancreatic secretory trypsin inhibitor (PSTI) is considered to be one of the acute phase reactants which increase after tissue injuries like surgery or major trauma. 25 patients were studied to investigate the changes in serum PSTI during and after heart surgery. 18 patients underwent the operation with the aid of cardiopulmonary bypass (CPB) - CPB group, and the other 7 patients, all pediatric cases, were treated under simple deep hypothermia by surface cooling without CPB -simple hyopothermia group. Serum amylase, serum C re-active protein (CRP), cardiac index and A-aDo, after surgery were examined, and the duration of CPB or circulatory arrest were recorded. The correlation between serum level of PSTI after surgery and these parameters were also studied.

During surgery, a transient elevation of serum PSTI was noticed in the period of CPB, but no significant change of serum PSTI was seen under simple deep hypothermia and circuratory arrest. On the first post operative day, a slight but significant increase of serum PSTI was seen in CPB group, on the other hand no significant increase was seen in simple hypothermia group. Postoperative increase of serum PSTI was correlated to circulatory arrest time in simple hypothermia group, and was inversely correlated to cardiac index determined immediately after the operationin CPB group. No correlation was seen between serum level of PSTI after surgery and serum amylase, CRP, A-aDo₂ or duration of CPB. Themagnitude of increase of serum PSTI after heart surgery was small, and did not seem to be well correlated to the extent of surgical insults.