摘要
目的:探讨围麻醉期乌司他丁对体外循环(CPB)下行心脏手术患者体内TNF-α和中性粒细胞弹性蛋白酶(PMNE)的影响。方法:择期心脏瓣膜置换患者24例,随机分为乌司他丁组(U组)和对照组(C组)。U组患者在麻醉后和转机时分别静脉泵注乌司他丁,泵注时间均为1 h。C组患者则给予等容积的生理盐水代替。分别于麻醉后手术前(T1),体外循环开始后30 min(T2),体外循环结束后1 h(T3),4 h(T4)和20 h(T5)抽取颈静脉球血。采用ELISA法测定颈静脉球血TNF-α和PMNE的浓度。结果:与各自T1相比,两组患者血浆TNF-α的浓度在T2,T3,T4,T5明显升高(P<0.01或P<0.05),T4达到高峰,T5开始下降。TNF-α的浓度C组在T2,T3,T4,T5时明显高于U组。C组患者颈静脉球血PMNE浓度在体外循环开始后均明显升高(P<0.01);U组则在T2,T3,T4明显升高(P<0.01),T5回落接近手术前但高于手术前水平(P<0.05)。而C组的PMNE浓度在T2,T3,T4,T5时升高幅度明显高于U组(P<0.01)。结论:乌司他丁可减轻CPB心脏手术患者体内的炎性反应,从而可能对CPB后机体损伤有一定的保护作用。
Objective： To investigate the effects of ulinastatin （UTI） on TNF-α and PMNE in patient during CPB. Methods： Twenty-four patients,undergoing elective cardiac valve replacement were randomly divided into 2 groups ： UIT group （ group U） and control group （ group C）. In group U, UTI was infused intravenously after the induction of anesthesia and infused intravenously during CPB respectively. Each infusion time was about 1 h. In group C, normal saline was given instead of UTI. Blood samples were taken from jugular bulb after induction of anesthesia （ T1 ）, after CPB 0.5 h （ T2）, after discontinuation of CPB 1 h （T3）,4 h （T4） and 20 h （T5） for determination of TNF-α and PMNE. Results： The concentration of TNF-α elevated dramatically at T2 ,T3 ,T4,T5 in both groups （P 〈0.01 ）. Albeit the concentration began to decease at T5 point, the values were still higher than T1 point in both groups. The concentration of PMNE from jugular bulb increased significantly after CPB（ P 〈0.01 ） in group C;in contrast to group C, the concentration of PMNE increased at T2 ,T3 ,T4 point（ P 〈0.01 ）in group U. At T5 point the concentration of PMNE decreased and was proximal to the level prior to CPB. Compared with group U,the extent of rise in PMNE was higher at T2, T3, T4, T5 in group C. Conclusion： Systemic inflammatory response during CPB can be alleviated by UTI. UTI may has the protective effects on the body injury during CPB.
出处
《江苏大学学报（医学版）》
CAS
2007年第5期419-421,共3页
Journal of Jiangsu University：Medicine Edition
关键词
乌司他丁
体外循环
炎性因子
ulinastatin
cardiopulmonary bypass
cytokine
