抑肽酶在体外循环肺保护机制中的作用  

Protective Effect of Aprotinin on Lungs in Cardiopulmonary Bypass Patients

作　　者：魏磊[1] 刘标[2] 梁永年[1] 陈亦江[1] 

机构地区：[1]江苏南京医科大学一附院心胸外科,江苏南京210029 [2]江苏南京医科大学一附院核医学科,江苏南京210029

出　　处：《中国体外循环杂志》2004年第3期145-147,144,共4页Chinese Journal of Extracorporeal Circulation

基　　金：南京医科大学科技发展基金项目 (2 0 0 0 0 33)

摘　　要：目的　研究CPB的肺损伤和抑肽酶的肺保护作用。方法　选择 2 4例患者随机分为两组 (各 12例 ) ,实验组在体外循环机中加入抑肽酶 10万KIU/Kg;对照组则不用抑肽酶。动态检测两组患者左右房中性粒细胞 (PMN)、血小板 (Pt)、IL - 6、IL - 10、TNF -α、肺泡氧合指数 (OI)。结果　两组转流前左、右房PMN、Pt无显著差异 ,对照组主动脉开放心脏复跳后 5分钟检测左房PMN、Pt明显低于右房 (P <0 .0 5 ) ;实验组左、右心房血中PMN、Pt无明显差异 (P >0 .0 5 )。CPB开始后 ,两组桡动脉血IL - 6、IL - 10、TNF -α进行性增高 ,对照组IL - 6、TNF -α增高更显著 (P <0 .0 5 )。实验组IL - 10增高更显著 (P<0 .0 5 )。CPB后实验组患者肺泡氧合指数 (OI)明显低于对照组(P <0 .0 5 )。结论　抑肽酶能通过保护血小板 ,抑制炎症因子IL - 6、TNF -α的产生 ,并能加速抗炎因子IL - 10的释放 ,从而抑制白细胞的激活、肺内聚集和扣留 ,减轻体外循环后肺损伤和通气功能障碍 。OBJECTIVE To evaluate the protective effect of aprotinin on lungs in cardiopulmonary bypass(CPB) patients. METHODS 24 patients undergoing open-heart surgery under CPB were randomly divided into two groups: control group and test group.The test group received the aprotinin. PMN and platelet(Pt) count, interleukin-6(IL-6) , interleukin-10(IL-10), tumor necrosis factor-α(TNF-α) and alveolar oxygenation index(OI) were recorded perioperatively in both groups.RESULTS PMN and Pt counts in the left atrial blood were significantly lower than that in the right atrium 5 min after aorta was unclamped in the control group(P<0.05). The plasma levels of IL-6 and TNF-α in the test group were significantly lower than the control group(P<0.05) .IL-10 in the test group increased compared with the control group(P<0.05) .OI in the control group was significantly higher than in the test group.CONCLUSION Aprotinin could protect lungs during cardiopulmonary bypass.

关 键 词：抑肽酶 IL—6 对照组 TNF—α PMN IL—10 体外循环 CPB 患者 OI 

分 类 号：R654.1[医药卫生—外科学]