乌司他丁和抑肽酶对小儿体外循环炎性反应的保护作用.docVIP

乌司他丁和抑肽酶对小儿体外循环炎性反应的保护作用 【摘要】nbsp; 目的:研究乌司他丁和抑肽酶对小儿体外循环（CPB）炎性反应的影响。方法:按入选标准筛选90例小儿先天性心脏病患者并随机分成六组：对照组 (A组)，小剂量乌司他丁组(B组)，大剂量乌司他丁组(C组)，小剂量抑肽酶组 (D组)，大剂量抑肽酶组 (E组)，小剂量乌司他丁+小剂量抑肽酶组(F组)，每组15例。于CPB前（T1）、升主动脉开放后5 min（T2）、CPB结束后30 min（T3）、4 h（T4）、24 h（T5）五个时间点抽取桡动脉血行白细胞(PMN)计数、IL-6、IL-8、IL-10、TNF-α浓度测定。术中定时监测ACT、HCT；同时记录主动脉阻断（ACC）时间、CPB时间、呼吸机支持时间、住院时间。结果:PMN计数各组差别不大。B、C、E、F组与A组相比，IL-6、IL-8、TNF-α明显降低，IL-10明显增高(均Plt;0.05)。与F组相比，A、B、D组IL-6，A、D组IL-8、TNF-α明显增高；A、B、C组IL-10明显降低 (均Plt;0.05)。C组与B组、E组与D组、C组与E组相比IL-6、IL-8、TNF-α显著降低；D组与E组、B组与D组、C组与E组相比IL-10显著降低 (均Plt;0.05)。F组呼吸机支持时间、住院时间较A组明显缩短(Plt;0.05)。结论:单次使用乌司他丁和抑肽酶都能减轻CPB所致的炎性反应，药效呈剂量依赖性；乌司他丁以抑制促炎因子IL-6、IL-8、TNF-α释放为著，抑肽酶以增加抑炎因子IL-10释放为著；同时使用小剂量乌司他丁加小剂量抑肽酶减轻炎性反应较为合理。 【关键词】nbsp; 乌司他丁 抑肽酶 体外循环 炎性反应 nbsp;nbsp;nbsp; Clinical study of ulinastatin on inflammatory response in children undergoing open heart surgery with CPB: comparison with aprotininnbsp; ZHAO Qi-feng, HU Xing-ti, DU Jie, et al. Department of Thoracic and Cardio Surgery, The 2nd Affiliated Hospital of Wenzhou Medical College, Wenzhou 325027 nbsp;nbsp;nbsp; Abstract:nbsp; Objective:To investigate the protective effect of ulinastatin and aprotinin on inflam-matory response in children open heart surgery with cardiopulmonary bypass(CPB). Methods: Ninety patients were selected on standard, and randomly divided into six group: control group (group A, n=15), small-dose ulinastatin group (group B, n=15), full-dose ulinastatin group(group C, n=15), small-dose aprotinin group (group D, n=15), full-dose aprotinin group (group E, n=15), small-dose ulinastatin + small-dose aprotinin group (group F, n=15). Arterial blood samples were taken before operation (T1), 5 min after release of the aortic cross-clamp (T2), and at 30 min (T3), 2 hours (T4), 24 hours (T5) after CPB termination for determination of polymorphonuclear (PMN) and plasma levels of IL-6, IL-8, IL-10 and TNF-α. Results:PMN varied similarly in every group. The plasma level of IL-6,IL-8,T