摘要
目的:观察乌司他丁对心脏瓣膜病行直视手术的患者术后的细胞因子及左心室功能的影响。方法:选择全身麻醉体外循环心脏瓣膜病60例,纽约心功能分级(New York Heart Association, NYHA)和美国麻醉协会(American Society of Anesthesiology, ASA)分级为Ⅱ~Ⅲ级。采用随机数字法分成两组,各30例。观察组在常规治疗的基础上在心脏停搏液内加入乌司他丁15 000 U/kg,常规组无此处理。两组患者分别于麻醉诱导前(T1)、体外循环后10 min(T2)、心脏瓣膜置换术后2 h(T3)及术后24 h(T4)从中心静脉插管采集血标本4次,测定心肌酸激酶同工酶、心肌钙蛋白,血清肿瘤坏死因子α(tumor necrosis factorα, TNF-α)、白细胞介素(interleukin, IL)-6、IL-8及IL-10。观察两组患者的血清细胞因子水平、术后血流动力学稳定情况和术后心功能恢复情况。结果:两组患者经过治疗后症状均明显好转,心功能明显改善。观察组各监测时刻的TNF-α、IL-6及IL-8水平均明显低于常规组(均P<0.05),而IL-10水平均高于常规组(均P<0.05)。两组左心室舒张末内径、左心室射血分数、右心房平均压、平均肺动脉压、体循环阻力比较差异均有统计学意义(均P<0.05)。结论:乌司他丁通过调节细胞因子的水平,减轻体外循环后的缺血再灌注损伤,改善左心室功能。
Objective:To evaluate the effects of ulinastain on cytokines and left ventricular function in patients after valve replacement.Methods:Sixty New York Heart Association(NYHA)and American Society of Anesthesiology(ASA)Ⅱ-Ⅲpatients scheduled for cardiac valve replacement with cardiopulmonary bypass(CPB)were randomly divided into two groups:general group(n=30)with normal treatment and processing group(n=30)with treated with blood cardioplegia solution mixed with Ulinastatin(15000 U/kg).Creatine kinase isoenzymes(CKMB),cardiac troponin(CTnI),tumor necrosis factorα(TNF-α),interleukin(IL)-6,IL-8,IL-10 analysis at the beginning(T1),10 min after the CPB(T2),2 h(T3)and 24 h(T4)after the end of surgery.The levels of Serum Cytokines,postoperative Hemodynamics stability and cardiac function were observed.Results:After treatment,the symptoms of both groups improved significantly,and the cardiac function improved significantly.TNF-a,IL-6 and IL-8 levels at T1-T4 Times in processing group were lower than those in the general group(P<0.05),in contrast,the IL-10 level in processing group was higher than that in the general group.Left ventricular end diastolic(LVEDD),ejection fraction(EF),mean right atrial pressure(MPRA),mean arterial blood pressure(MPAP),systemic vascular resistance(SVR)have significantly variation in the processing group compared with the general group respectively(P<0.05).Conclusion:Ulinastain can significantly improves left heart function by regulating the level of cytokines and alleviating the ischemia-reperfusion injury after cardiopulmonary bypass.
作者
王冲
顾亮
伯平
WANG Chong;GU Liang;BO Ping(Department of Cardiothoracic Surgery,Nantong Rich Hospital,Fourth Clinical College of Yangzhou University,Nantong 226010;Department of Cardiothoracic Surgery,Beijing Anzhen Hospital)
出处
《南通大学学报（医学版）》
2019年第6期448-450,共3页
Journal of Nantong University(Medical sciences)
基金
南通市“十三五”科教强卫工程青年医学重点人才专项基金资助项目(青年039)
关键词
心脏瓣膜手术
乌司他丁
细胞因子
左心室功能
heart valve replacement surgery
ulinastain
cytokines
left ventricular function
