Nagaoka H, Yamada T, Hatano R, Tsukuura T, Sakamoto T
Jpn J Surg. 1975 Dec;5(4):222-33. doi: 10.1007/BF02469765.
Activation of the kinin system and effects of Trasylol (Bayer, A.G. Lebukusen, West Germany), a kallikrein inhibitor, were investigated on 52 patients during hemodilutional cardiopulmonary bypass (CPB). Immediately after the start of CPB, neither elevation of bradykinin nor reduction of plasma kininogen (KGN: a precursor of bradykinin) were observed. During CPB, bradykinin level in the blood was markedly elevated, correlating with the significant decrease of kininogen (p less than 0.001). The longer the CPB time, the more marked the reduction of KGN. In the cases requiring over 60 minutes of CPB, the amounts of bradykinin released (4.6-18.0ng/ml) were sufficient to increase capillary permeability as well as peripheral vasodilatation. As shown by the sufnificant increase of hematocrit (p less than 0.005) and the extreme reduction of vascular resistance found at the end of CPB in the prolonged cases. Infusion of Trasylol into the extracorporeal circuit actually prevented the reduction of kininogen and the increase of hematocrit as well as the extreme decrease of vascular resistance in the cases of over 60 minutes CPB. These results clearly point out that Trasylol is beneficial for the prevention of bradykinin liberation and capillary permeability increase and for the maintenance of optimum peripheral vascular tone during CPB. Furthermore, the significance of these findings with regards to complications during and after prolonged CPB was discussed.
在52例患者进行血液稀释心肺转流术（CPB）期间，研究了激肽系统的激活以及激肽释放酶抑制剂抑肽酶（德国拜耳公司，勒沃库森）的作用。CPB开始后即刻，未观察到缓激肽升高或血浆激肽原（KGN：缓激肽的前体）降低。在CPB期间，血液中的缓激肽水平显著升高，与激肽原的显著降低相关（p<0.001）。CPB时间越长，KGN的降低越明显。在CPB时间超过60分钟的病例中，释放的缓激肽量（4.6 - 18.0ng/ml）足以增加毛细血管通透性以及外周血管扩张。在延长CPB时间的病例中，CPB结束时血细胞比容显著增加（p<0.005）以及血管阻力极度降低表明了这一点。在CPB时间超过60分钟的病例中，将抑肽酶注入体外循环实际上可防止激肽原降低、血细胞比容增加以及血管阻力极度降低。这些结果清楚地表明，抑肽酶有利于预防缓激肽释放和毛细血管通透性增加，并有利于在CPB期间维持最佳外周血管张力。此外，还讨论了这些发现对于延长CPB期间及之后并发症的意义。
