乌司他丁对体外循环心脏手术患者体内TNFα和中性粒细胞弹性蛋白酶的影响.docVIP

乌司他丁对体外循环心脏手术患者体内TNF－α和中性粒细胞弹性蛋白酶的影响 作者:邵东华,杭黎华,傅诚章 作者单位：1.江苏大学附属人民医院麻醉科，江苏 镇江212001；2. 南京医科大学第一临床学院麻醉科，江苏 南京 210029 【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(P0.01或P0.05)，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(P0.01)；U组则在T2，T3，T4明显升高（P0.01），T5回落接近手术前但高于手术前水平（P0.05）。而C组的PMNE浓度在T2，T3，T4，T5时升高幅度明显高于U组（P0.01）。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。 【关键词】 乌司他丁　体外循环　炎性因子 　　Effect of ulinastatin on TNFΑ and PMNE in patient during cardiopulmonary bypass 　　SHAO Donghua， HANG Lihua， FU Chengzhang， WANG Hong， YANG Yinghong 　　1.Department of Anesthesiology，the Affliated Peoples hospital of Jiangsu University，Zhenjiang Jiangsu 212001； 　　2. Department of Anesthesiology，the First Clinic Medical College of Nanjing Medical University，Nanjing Jiangsu 210029，China 　　［Abstract］ 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 (P0.01). Albeit the concentration began to decease at T5 point，the values were still higher than T1 point in both gro