摘要
目的观察乌司他丁对体外循环（CPB）下法洛四联症根治术患儿心肌损伤的影响。
方法择期行CPB下法洛四联症根治术的患儿共80例，采用随机数字表法将患儿分为两组，每组40例：乌司他丁组（U组）患儿于CPB前30 min静脉输注乌司他丁2万U/kg，对照组（C组）患儿于相同时间点静脉输注等容量生理盐水。分别于麻醉诱导前（T0）、诱导后10 min（T1）、复温至36 ℃ （T2）、CPB停机后1 h （T3）、术毕（T4）及术后24 h （T5）时抽取桡动脉以测定患儿血浆心肌肌钙蛋白T （cTnT）浓度。分别于打开心包时及主动脉开放后1 h时取右心耳组织，光镜下检测心肌组织病理学的改变，电镜下检测心肌组织超微结构的改变。反转录-聚合酶链反应（RT-PCR）检测心肌组织核因子-κB（NF-κB）及Toll样受体4（TLR4） mRNA表达，Western blot法检测心肌组织NF-κB及TLR4蛋白表达。
结果与C组[（0.338±0.043）、（0.388±0.064）、（0.446±0.078）、（0.342±0.064） ng/ml]比较，U组患儿T2～T5时血浆cTnT浓度[（0.193±0.039）、（0.255±0.058）、（0.318±0.055）、（0.233±0.047） ng/ml]均降低（t＝15.800，P＝0.000；t＝9.739，P＝0.000；t＝8.482，P＝0.000；t＝8.682，P＝0.000）。U组患儿主动脉开放后1 h时心肌组织病理学及超微结构损伤均较C组减轻。与C组（0.82±0.23、0.77±0.18；0.67±0.15、0.75±0.16）比较，U组患儿主动脉开放后1 h时的心肌组织NF-κB及TLR4 mRNA及蛋白表达（0.57±0.17、0.56±0.13；0.45±0.10、0.55±0.13）均降低（t＝5.528，P＝0.000；t＝5.982，P＝0.000；t＝7.718，P＝0.000；t＝6.136，P＝0.000）。
结论乌司他丁可减轻CPB下法洛四联症根治术患儿的心肌损伤，其机制可能与其下调NF-κB及TLR4的表达有关。
Objective To explore the effect of ulinastatin on myocardial injury in pediatric pa- tents undergoing radical correction of tetralogy of Fallot with cardiopulmonary bypass （CPB）. Methods A total of 80 pediatric patients undergoing radical correction of tetralogy of Fallot with CPB, in according to random number table, were randomly divided into two groups （n =40 each）. Pediatric patients were injec- ted intravenously with ulilmstatin at a dose of 20 000 U/kg or with the same volume normal saline 30 min before CPB in ulirmstatin group （group U） or control group （group C） respectively. Radial artery blood was collected to determine the concentration of plasma cardiac treponin T （cTnT） before anesthesia induetion （T0）, 10 rain after anesthesia induction （T1）, the onset of re -warming to 36℃ （T2）, 1 h after CPB stopping （ T3 ）, immediately when surgery end （ T4 ） and 24 h after surgery （ T5 ）, respectively. Right auricular appendage was obtained after opening of pefieardiam and at 1 h after aortic unelamping, and the change of cardiac muscle tissue pathology was detected by light microscope. The change of ultra- structure of cardiac muscle tissue was observed by using transmission electron microscope. The expression of nuclear factor - κB （ NF - κB ） and toll - like receptor 4 （TLR4） mRNAs was detected by reverse tran- scription -polymerase chain reaction （RT- PCR）. The expression levels of NF - KB and TLR4 proteins were tested by Western blotting. Results Compared to group C [ （0. 338 ±0. 043 ）, （0. 388 ± 0. 064 ）, （0.446±0.078）, （0.342 ±0.064） ng/ml], the levels of plasma cTnT from T2 to T5 [（0. 193 ±0. 039）, （0. 255 ±0. 058）, （0. 318 ±0. 055）, （0. 233 ±0. 047） ng/mll were significantly reduced （t = 15.800, P=0. 000; t =9.739, P=0. 000; t =8.482, P=0. 000; t =8.682, P=0. 000） in group U. Pathological damage and uhrastructure injury of myocardial tissue in group U were significantly alleviated as compared with tho
出处
《中华实验外科杂志》
CAS
CSCD
北大核心
2017年第2期321-324,共4页
Chinese Journal of Experimental Surgery
关键词
乌司他丁
心肌损伤
心肺转流术
法洛四联症根治术
小儿
Ulinastatin
Myocardial injury
Cardiopulmonary bypass
Radical correction of tetralogy of fallot
Pediatric
