Eriksson M, Saldeen T
Department of Anesthesiology and Intensive care, University Hospital, Uppsala, Sweden.
Acta Anaesthesiol Scand. 1995 Feb;39(2):163-6. doi: 10.1111/j.1399-6576.1995.tb04036.x.
Dextran is known to increase the plasminogen activation rate in vitro and to decrease the alpha2-antiplasmin activity. We decided to explore the effect of dextran on plasma tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) during surgical trauma. Thirty-one patients undergoing elective surgery were given 500 ml of 6% dextran 70. Another nine patients serving as controls were given 500 ml of a glucose-electrolyte solution. The activities of t-PA and PAI-1 during surgery were determined, as was the concentration of t-PA antigen. PAI-1 activity was decreased by 19% after infusion of 250 ml of dextran. After 500 ml, the activity was reduced by 22% (both P < 0.05). The activity of t-PA was increased by 43% and 29% (both P < 0.05) and the antigenic amount of t-PA was increased by 18% and 15% (both P < 0.05) after infusion of 250 ml and 500 ml of dextran, respectively. No changes in these variables were observed in the control patients. It is concluded that infusion of dextran promotes fibrinolysis by enhancing plasminogen activation in patients subjected to trauma. Since elevated levels of PAI-1 prior to surgery are known to predispose to deep vein thrombosis, which may form already during the operation, the effect of dextran on PAI-1 described here may explain its clot preventing properties.
已知右旋糖酐可在体外提高纤溶酶原激活率并降低α2 -抗纤溶酶活性。我们决定探究右旋糖酐在手术创伤期间对血浆组织型纤溶酶原激活物（t - PA）和纤溶酶原激活物抑制剂 - 1（PAI - 1）的影响。31例行择期手术的患者输注了500毫升6%的右旋糖酐70。另外9例作为对照的患者输注了500毫升葡萄糖电解质溶液。测定了手术期间t - PA和PAI - 1的活性以及t - PA抗原浓度。输注250毫升右旋糖酐后，PAI - 1活性降低了19%。输注500毫升后，活性降低了22%（两者P < 0.05）。输注250毫升和500毫升右旋糖酐后，t - PA的活性分别提高了43%和29%（两者P < 0.05），t - PA的抗原量分别增加了18%和15%（两者P < 0.05）。对照患者中未观察到这些变量的变化。得出结论，输注右旋糖酐可通过增强创伤患者的纤溶酶原激活来促进纤维蛋白溶解。由于术前PAI - 1水平升高已知易导致深静脉血栓形成，而深静脉血栓可能在手术期间就已形成，此处所描述的右旋糖酐对PAI - 1的作用可能解释了其预防血栓形成的特性。
