Bui K C, Hammerman C, Hirschl R B, Hill V, Snedecor S M, Schumacher R, Bartlett R H
Department of Pediatrics, Wyler Children's Hospital, University of Chicago, Pritzker School of Medicine, Ill.
J Thorac Cardiovasc Surg. 1991 Jun;101(6):973-83.
Thromboxane may be a mediator of pulmonary hypertension in the neonate. Acute thromboxane-mediated pulmonary hypertension has been described in sheep receiving extracorporeal membrane oxygenation, which raises concerns about a potential thromboxane-mediated exacerbation of pulmonary hypertension in human neonates with severe pulmonary hypertension who are treated with extracorporeal membrane oxygenation. We measured plasma levels of thromboxane, prostaglandin F2 alpha, and 6-keto-prostaglandin F1 alpha in infants with pulmonary hypertension, some of whom were treated medically and some of whom were treated with extracorporeal membrane oxygenation. Plasma levels of all three prostanoids were elevated in infants with pulmonary hypertension and decreased with time, whether the neonates were treated with extracorporeal membrane oxygenation or with medical management alone. In infants treated with extracorporeal membrane oxygenation, we collected samples simultaneously from preoxygenator sites, postoxygenator sites, and umbilical artery catheter. We could demonstrate no significant difference in plasma prostanoid levels across the oxygenator. In two patients, plasma thromboxane and prostaglandin F2 alpha levels measured shortly after a platelet transfusion were distinctly higher in the umbilical artery catheter than in venous samples.
血栓素可能是新生儿肺动脉高压的介质。在接受体外膜肺氧合的绵羊中已描述了急性血栓素介导的肺动脉高压，这引发了人们对接受体外膜肺氧合治疗的重度肺动脉高压人类新生儿中血栓素介导的肺动脉高压潜在加重的担忧。我们测量了患有肺动脉高压婴儿的血浆血栓素、前列腺素F2α和6-酮-前列腺素F1α水平，其中一些婴儿接受了药物治疗，一些婴儿接受了体外膜肺氧合治疗。无论新生儿接受体外膜肺氧合治疗还是仅接受药物治疗，患有肺动脉高压的婴儿这三种前列腺素的血浆水平均升高，并随时间下降。在接受体外膜肺氧合治疗的婴儿中，我们同时从前氧合器部位、后氧合器部位和脐动脉导管采集样本。我们未能证明氧合器前后血浆前列腺素水平存在显著差异。在两名患者中，血小板输注后不久在脐动脉导管中测得的血浆血栓素和前列腺素F2α水平明显高于静脉样本。
