体外循环期间乌司他丁对炎性因子变化的影响  

Effects of ulinastatin on inflammatory factors during cardiopulmo nary bypass

作　　者：强喆[1] 周丕均[2] 李玉兰[2] 李天成[3] 陈春红[3] 

机构地区：[1]天津市第一中心医院麻醉科,天津300192 [2]兰州医学院第一附属医院麻醉科,甘肃兰州730000 [3]兰州医学院第一附属医院心外科,甘肃兰州730000

出　　处：《医师进修杂志（外科版）》2004年第12期24-25,28,共3页

摘　　要：目的　观察乌司他丁 (UTI)对体外循环 (CPB)心脏手术期间体液因子变化的影响 ,探讨其手术期间的保护作用。方法　 30例择期CPB心脏手术病人 ,随机分为两组 (每组 15例 ) ,乌司他丁组 (U组 )给予乌司他丁 2万U kg ,对照组 (C组 )给予等量的生理盐水。分别于麻醉诱导后 (t1 )、主动脉开放后 10min(t2 )、CPB停机后 10min(t3)、CPB停机后 1h(t4 )测定血浆TNF -α、ET - 1、TXA2 的水平及血浆丙二醛 (MDA)的浓度和过氧化物歧化酶 (SOD)的活性。结果　两组的TNF -α在t2 升高 ,U组在t3开始下降 ,C组持续至t4 与基础值相比仍明显升高。ET - 1在t2 升高 ,并逐渐下降 ,两组比较差异无显著性意义。两组MDA在t2 、t3升高 ,但U组明显低于C组 ,且U组MDA在t4 恢复至基础水平 ,而C组仍明显高于基础值 (P <0 .0 1)。两组的SOD活性在主动脉开放后至CPB停机后 1h持续升高 ,在t2 、t3U组SOD活性显著高于C组 (P <0 .0 1)。两组的TXA2 在t2 、t3较t1 明显升高 ,且C组与U组相比差异有显著性意义 ,U组的TXA2 在t4 已恢复至基础值 ,C组仍明显高于基础值。结论　乌司他丁可以抑制体外循环时TNF -α、TXA2 等炎性因子的产生 ,并能提高SOD的活性 ,在行体外循环的心脏手术中应用前景广阔。Objective\ To investigate the effects of ulinastatin on tumor necros is factor(TNF-α), endothelin-1(ET-1), throbonxane A 2(TXA 2), maleic dialde hyde (MDA)and superoxide dismutase(SOD) during the operation on heart with cardio pulmonary bypass (CPB).Methods\ 30 ASA Ⅱ～Ⅲ patients who underwent elective heart surgery w ere divided into two groups randomly,15 patients in ulinastatin group rece ived ulinastatin 20 000 U/kg,15 patients in control group received sam e volume of saline instead of ulinastatin. Arterial blood samples were taken at the beginning of surgery(t 1), 10 min after aortic release(t 2), 10 min(t 3) and 1 h (t 4) after discontinuation of CPB for blood gas analysis, venous blood samp les were taken at the same time for determination of plasma levels of TNF-α, ET-1, TXA 2, MDA and SOD activity.Results\ There was no significant diff ere nce between two groups in plasma TNF-α, ET-1, TXA 2, MDA level and SOD activit y before CPB in both groups. The plasma level of TNF-α increased at t 2 in both gr oups and was still high at t 4 in control group but not in ulinastatin group. T he plasma level of ET-1 was increased at t 2 and then decreased in both groups. The plasma level of MDA at t 2 and t 3 was higher than that at baseline in both g roup s, and the level of it in ulinastatin group was significantly lower than that in control group, it returned to the baseline at t 4 in ulinastatin group but was s till high in control group. The plasma activity of SOD increased significantly a t t 2 and t 4 in both groups, and the activity in ulinastatin group was higher tha n that in control group(P<0.01). The plasma level of TXA 2 in ulin astatin group w as significantly lower than that in control group at t 2 and t 3, and it retur ned to baseline at t 4 in ulinastatin group. Conclusions\ Ulinastatin c an improve the respiratory function during CPB by inhibiting the production of TNF -α, TXA 2 and enhancing the plasma activity of SOD.

关 键 词：心肺转流术 胰蛋白酶抑制剂 炎性反应 

分 类 号：R614.1[医药卫生—麻醉学]