蛋白酶抑制剂对原位肝移植术中促炎性细胞因子与氧自由基代谢的影响.docVIP

蛋白酶抑制剂对原位肝移植术中促炎性细胞因子和氧自由基代谢的影响 作者：冯国辉,雷志礼,宇鹏 【关键词】 蛋白酶抑制剂；肝移植；促炎性细胞因子；氧自由基 　　［摘要］ 目的 评价蛋白酶抑制剂乌司他丁（ulinary trypsin inhibitor,UTI)对原位肝移植术（orthotopic liver transplantation,OLT)中血浆促炎性细胞因子和氧自由基代谢水平的影响。方法 将20例择期行OLT手术患者随机分为两组。UTI组（U组，n=10)：切皮后将UTI 30万u加入100ml生理盐水，持续静脉输注1h，然后每4h重复1次。对照组（C组，n=10)：以等容量生理盐水代替。分别于麻醉后切皮前（T0)、无肝前期120min（T1)、无肝期30min（T2)、新肝期5min（T3)、新肝期60min（T4)和术毕（T5)抽取静脉血测定血浆IL-6、IL-8、TNF-Α和丙二醛（MDA)浓度，以及超氧化物歧化酶（SOD)活性。术中连续监测心输出量、混合静脉血氧饱和度、中心温度、ECG、CVP、PETCO2、SpO2、桡动脉压、肺动脉压。维持中心温度不低于35.5℃。结果 T0时组间血浆IL-6、IL-8、TNF-Α、MDA和SOD水平差异均无显著性（P＞0.05)。与T0比较，两组血浆IL-6、IL-8从T2～T5各时间点均升高（P＜0.01)；两组血浆TNF-Α从T1～T5各时间点均升高（P＜0.05或0.01)；两组血浆MDA从T3～T5各时间点均升高（P＜0.05或0.01)；C组血浆SOD从T3～T5各时间点降低（P＜0.01)；U组血浆SOD仅在T3时降低（P＜0.05)。与C组比较，U组血浆IL-6、IL-8水平在T2～T5各时间点降低（P＜0.05或0.01)，TNF-Α和MDA水平在T3～T5各时间点降低（P＜0.05或0.01)，SOD水平在T3～T5各时间点升高（P＜0.05)。结论 UTI可抑制OLT导致的全身性炎性反应，减少自由基的产生。 ［关键词］ 蛋白酶抑制剂；肝移植；促炎性细胞因子；氧自由基 Effects of ulinastatin on proinflammatory cytokines and oxygen free radicals during orthotopic liver transplantation FENG Guo-hui,LEI Zhi-li,YU Peng,et al.Department of Anesthesia,General Hospital of Chinese Peoples Armed Police Forces,Beijing 100039,China ［Abstract］ Objective To evaluate the effects of ulinastatin on proinflammatory cytokines and oxygen free radical during orthotopic liver transplantation(OLT).Methods Twenty ASA Ⅲ～Ⅳ patients with end-stage liver diseases,undergoing OLT were randomly divided into two groups.Ulinastatin group received intravenous infusion of ulinastatin 3×105IU in 100ml normal saline after skin incision and every 4 hours thereafter(n=10).Control group received same amount of normal saline instead of ulinastatin(n=10).Blood samples were taken before skin incision(T0),120min after skin incision(T1),30min after liver was removed(T2),5min (T3) and 60min (T4) after reperfusion of the graft and at the end of operation (T5)for determination of plasma IL-6,IL-8,TNF-Α,MDA concentration and SOD activity.After ane