乌司他丁在婴幼儿心肺转流心脏直视手术中的应用  

Application of ulinastatin during open-heart surgery under cardiopulmonary bypass in infants

作　　者：陈煜[1] 张剑蔚[1] 周泓[1] 白洁[1] 

机构地区：[1]上海第二医科大学附属新华医院上海儿童医学中心麻醉科,上海市200127

出　　处：《临床麻醉学杂志》2005年第8期527-530,共4页Journal of Clinical Anesthesiology

摘　　要：目的比较乌司他丁(UTI)和抑肽酶在婴幼儿心肺转流(CPB)心内直视手术期间对炎性介质和细胞因子的抑制作用以及对呼吸系统总顺应性的影响。方法48例室间隔缺损(VSD)患儿随机分为四组:U组,UTI10kIU/kg;Ap组,抑肽酶100kIU/kg;UA组,UTI5kIU/kg加抑肽酶100kIU/kg和C组(对照组),每组12例。于麻醉诱导后(T1)、CPB结束(T2)和术后2h(T3)采血检测白细胞介素-6(IL-6)、IL-8、IL-10和肿瘤坏死因子α(TNF-α),并同时监测血液动力学和呼吸系统总顺应性(Crs)等。结果CPB期间C组和Ap组的IL-6、IL-8血浆水平增高幅度较为显著(P<0.01),且术后恢复较慢;IL-10在T2时除Ap组仅有轻微改变外,其余三组均升高(P<0.01),至T3时仍呈升高趋势;各组TNF-α的血浆水平升高均较为显著(P<0.01),尤以C组为甚。血浆细胞因子和炎性介质的改变与呼吸功能呈负相关,U组Crs变化轻微,其他各组Crs均显著降低。结论UTI能安全有效地应用于婴幼儿,通过抑制CPB心脏直视手术患儿围术期促炎细胞因子的释放,减轻CPB引起的急性炎症反应,改善呼吸系统顺应性而具肺保护功能。其作用较抑肽酶显著。Objective To compare the ability of ulinastatin with aprotinin to inhibit inflammatory factors, and their effects on lung compliance. Methods Forty-eight infants with VSD under cardiopulmonary bypass were randomly classified into 4 groups with 12 cases each. Group U treated with UTI 10 kIU/kg,group Ap aprotinin 100 kIU/kg, group UA UTI 5 kIU/kg and aproinin 100 kIU/kg and group C as control group. The blood samples were collected just after induction （T1）, at the completion of CPB （T2） and 2 hours after operation （T3）. Tumor necrosis factor α（TNF-α）, interleukin-6 （IL-6） ,IL-8 and IL-10 in plasma were detected. At the same time points, the hemodynamics and respiratory system compliance （Crs） were speculated. Results Plasma concentration of IL-6 and IL-8 in group C and Ap was raised obviously （P〈0. 01） and resumed slowly. IL-10 at T2 was increased highly except for group Ap, which was changed a little, the trend of increase retained till T3. TNF-α in each group was obviously increased （P〈0.01）, especially in group C. The change of plasma cytokines and inflammatory factors were negatively correlated with that of respiratory function. Crs was little changed in group U, and decreased apparently in the other groups. Conclusion Ulinastatin could be used in infants with safety and effectiveness. It can clown-regulate cytokines in CHD children undergoing cardiopulmonary bypass, resulting in lighter acute inflammatory response,less increase of Crs and protecting lung function, in which ulinastatin is better than aprotinin.

关 键 词：乌司他丁 婴幼儿 心肺转流心脏直视手术 抑肽酶 血液动力学 

分 类 号：R726.1[医药卫生—儿科]