Jung M, Koppensteiner R, Graninger W, Minar E, Kretschmer G, Ehringer H
Angiologische Abteilung, 1. Medizinischen Universitätsklinik, Wien.
Klin Wochenschr. 1988 May 2;66(9):379-84. doi: 10.1007/BF01737940.
In 39 patients with hemodynamically significant stenoses of the internal carotid artery thrombendarterectomy was performed. Hemorheological properties and plasma protein levels were studied pre- and postoperatively over a period of 14 days. In comparison to age-matched healthy controls preoperative plasma viscosity, red cell aggregation, fibrinogen, haptoglobin and alpha-1-antitrypsin were significantly elevated. After surgical trauma there was an increase in fibrinogen, alpha-1-antitrypsin, haptoglobin and ceruloplasmin, whereas alpha-2-macroglobulin, immunoglobulin A and immunoglobulin G decreased significantly. Plasma viscosity, red cell aggregation, red cell filterability, fibronectin and immunoglobulin M remained unchanged. We conclude that our patients showed a non specific chronic "hematological stress syndrome" with raised acute phase reactants and corresponding hemorheological changes preoperatively; despite postoperative acute phase reaction no further deterioration of the rheological parameters could be observed; this might be caused by a decrease of plasma proteins with high frictional ratios compensating the increase of acute phase proteins. Besides, tissue damage and consecutive acute phase reaction in carotid arterial surgery seem to be of relatively minor degree.
对39例患有血流动力学显著的颈内动脉狭窄的患者实施了血栓内膜切除术。在术后14天内对血液流变学特性和血浆蛋白水平进行了术前和术后研究。与年龄匹配的健康对照相比，术前血浆粘度、红细胞聚集、纤维蛋白原、触珠蛋白和α-1抗胰蛋白酶显著升高。手术创伤后，纤维蛋白原、α-1抗胰蛋白酶、触珠蛋白和铜蓝蛋白增加，而α-2巨球蛋白、免疫球蛋白A和免疫球蛋白G显著降低。血浆粘度、红细胞聚集、红细胞滤过率、纤连蛋白和免疫球蛋白M保持不变。我们得出结论，我们的患者术前表现出一种非特异性慢性“血液应激综合征”，伴有急性期反应物升高和相应的血液流变学变化；尽管术后有急性期反应，但未观察到流变学参数进一步恶化；这可能是由于具有高摩擦比的血浆蛋白减少，抵消了急性期蛋白的增加。此外，颈动脉手术中的组织损伤和随之而来的急性期反应似乎程度相对较轻。
