摘要
目的:探讨乌司他丁对体外循环心脏手术患者脑炎性反应的影响。方法:选择24例择期行心脏瓣膜置换术患者,随机分为乌司他丁组(U组)和对照组(C组),每组12例。U组患者给予乌司他丁2.4×104U/kg,其中1.2×104U/kg于麻醉诱导后静脉注射,0.6×104U/kg加于体外循环预充液中随转流进入体内,0.6×104U/kg于主动脉开放前约5min加入体外循环机内。C组患者用等量容积的生理盐水代替。于麻醉后手术前(T1)、体外循环结束后60min(T2)、体外循环结束后6h(T3)同时抽取动脉血与颈静脉球血,测定肿瘤坏死因子α(TNFα),白细胞介素6,8,10(IL-6,IL-8,IL-10),并计算颈静脉球血与动脉血各细胞因子之差△TNFα,△IL-6,△IL-8,△IL-10。结果:C组T2时动脉血TNF,αIL-6,IL-8,IL-10及△TNFα,△IL-8,△IL-10显著升高(P<0.01),T3时TNF,αIL-6,IL-8,IL-10及△TNFα,△IL-6,△IL-10明显升高(P<0.01),△IL-8亦升高(P<0.05);U组T2时IL-6,IL-8,IL-10显著升高(P<0.01),TNFα,△TNFα,△IL-10亦升高(P<0.05),T3时IL-6,IL-8,IL-10,△TNFα,△IL-8显著升高(P<0.01),△IL-6,△IL-10亦升高(P<0.05)。T2时U组动脉血TNF,αIL-6及△TNFα,△IL-8低于C组(P<0.05),动脉血IL-8显著低于C组(P<0.01);T3时U组动脉血TNFα及△IL-6低于C组(P<0.05),U组动脉血IL-6,IL-8显著低于C组(P<0.01),动脉血IL-10与△IL-10高于C组(P<0.05)。结论:乌司他丁可以减轻体外循环手术患者全身和脑局部的炎性反应。
Objective To investigate the effects of ulinastatin （UTI） on cerebral inflammatory response during cardiopulmonary bypass （CPB）. Methods Twenty-four NYHA Ⅱ-Ⅲ patients （13 males and 11 females） aged 23-45 years, undergoing elective cardiac valve replacement under hypothermic CPB were randomly divided into 2 groups： ulinastatin group （Group U, n=12） and control group （Group C, n=12）. In group U, UTI （1.2×10^4U/kg） was given intravenously after the induction of anesthesia, 0.6×10^4 U/kg UTI was added to the priming solution, and 0.6×10^4 U/kg UTI was given about 5 rain before the aortic decamping. In Group C, normal saline was given instead of UTI. Internal jugular vein was cannulated and the catheter was advanced retrogradely till jugular bulb. Blood samples were taken simultaneously from artery and jugular bulb after induction of anesthesia（ T1 ） , 60 min （ T2 ） and 6 h （ T3 ） after discontinuation of CPB for determination of TNFα, IL-6, IL-8 and IL-10. The juguloarterial gradients of these cytokines （ ΔTNFα, ΔIL-6, ΔIL-8,and ΔIL-10） were calculated. Results In Group C, arterial levels of TNFα,IL-6,IL-8, IL-10 at T2 and T3, ATNFα, ΔIL-8 and ΔIL-10 at T2, ΔTNFα, ΔIL-6 and ΔIL-10 at T3 significantly increased （P〈0. 01）0.05）. In Group U, arterial levels of IL-6, IL-8, IL-10 at T2, arterial ΔIL-8 increased at T3 （P〈levels of IL-6, IL-8, IL-10 and TNFα,ΔIL-8 at T3 significantly increased （P〈0.01）. Arterial levels of TNFα at T2 and T3, ΔTNFα,ΔIL-10 at T2,ΔIL-6 at T3 increased （P〈0.05）. Arterial levels of TNFΔ ,IL-6 and Δ TNFα, IL-8 at T2, arterial levels of TNFα and ΔIL-6 at T3 in Group U were lower than those in Group C （P〈0.05）. Arterial levels of IL-6 at T3, IL-8 at T2 and T3 in Group U were significantly lower than those in Group C （P〈0.01 ）. Arterial levels of IL-10 and ΔIL-10 at T3 in Group U were higher than those in Group C （P 〈0.05）. Conclusion Systemic and cerebral activation of inflammatory
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2005年第4期420-423,共4页
Journal of Central South University ：Medical Science
关键词
乌司他丁
心肺转流术
脑
炎性反应
ulinastatin
cardiopulmonary bypass
brain
inflammatory, response
