摘要
目的观察乌司他丁对体外循环下联合瓣膜置换术患者血浆炎性细胞因子白细胞介素6（IL-6）、抗炎细胞因子白细胞介素10（IL-10）及术后早期认知功能的影响,探讨其对脑损伤的影响以及脑保护机制。方法择期于我院行心脏联合瓣膜置换术（二尖瓣置换＋主动脉瓣置换术）的患者40例,按NYHA分级标准心功能Ⅱ∽Ⅲ级。随机分为实验组和对照组,n=20。均采用静吸复合麻醉,实验组于麻醉诱导后静脉泵入乌司他丁1.2万U·kg-1,CPB预充液中加入乌司他丁0.6万U·kg-1,主动脉开放前5min,CPB加入乌司他丁0.6万U·kg-1;对照组给予等容量生理盐水。分别于麻醉诱导给药前（T1）、CPB开始后30min（T2）、CPB结束后30min（T3）、CPB结束后3h（T4）、CPB结束后6h（T5）及术后24h（T6）,抽取各组颈静脉球血,采用ELISA法测定IL-6及IL-10的浓度。采用简易智能状态量表（MMSE）,于术前1天及术后第二、七天对患者进行评分并判断是否发生术后早期认知功能障碍（早期POCD）。结果实验组中T2-T6时点血浆IL-6浓度明显低于对照组,IL-10浓度明显高于对照组（P〈0.05）,实验组早期POCD发生率明显低于对照组,差异具有统计学意义（P〈0.05）。结论使用乌司他丁可以抑制体外循环联合瓣膜置换术后炎症反应,同时可以降低早期认知功能障碍的发生率,具有脑保护作用。
OBJECTIVE To observe the effects of ulinastatin on inflammatory cytokine interleukin 6（IL-6）,an-ti-inflammatory cytokines IL-10 and early post-operative cognitive function of the patients undergoing cardiac com-bined valve replacement surgery with cardiopulmonary bypass.To explore the effect of ulinastatin on brain injury and mechanismonbrainprotection.METHODS 40patientswhowereundergoingcardiaccombinedvalvereplacement surgery （ combined mitral valve replacement with aortic valve replacement） in our hospital,whose heart function were classⅡ∽Ⅲaccording to the NYHA classification standard heart function,were randomly divided into experimental group and control group, n=20.Intravenous inhalation anesthesia were adopted.The patients of experimental group received ulinastatin 12000U· kg-1 before incision by intravenously pumping,6000U· kg-1 ulinastatin was added to the priming solution,and 6000U· kg -1 ulinastatin was given before 5min of the aortic decamping.The patients of control group were given equal volume of physiological saline.Jugular bulb blood of each group were drew off before administration of anesthesia induction（T1）,30min after CPB（T2）,30min after the end of CPB（T3）,3h after the end of operation（T4）,6h after the end of operation（T5）,and 24h after the end of operation（T6）.Serum concentration of IL-6 and IL-10 were measured by ELISA.Patients were investigated by using mini mental state examination （ MMSE） in 1 days before operation, 2 day after operation and 7 day after operation to determine whether the POCD oc-curred.RESULTS The concentration of the IL-6 was lower in T2 ~T6 point of experimental group than control group（P〈0.05）.The concentration of IL-10 in experimental group was significantly higher than control group（P〈0.05）.The incidence of POCD experimental group was significantly lower than that of control group with statistical difference（ P〈0.05 ）.CONCLUSION Ulinastatin can inhibit inflammatory reaction after the cardiac combined valve
出处
《海峡药学》
2015年第5期74-76,共3页
Strait Pharmaceutical Journal
关键词
心脏联合瓣膜置换术
炎性因子
乌司他丁
Cardiac combined valve replacement surgery
Inflammatory cytokines
Ulinastatin
