体外循环心内直视手术围术期乌司他丁对血浆S100β蛋白及TNF-α表达的影响  

Effect of nlinastatin on expression of S100β protein and TNF-α in patients undergoing open-heart surgery with cardiopulmonary bypass

作　　者：张秀来[1] 王屹[1] 周海燕[1] 姚媛媛[1] 叶怀庄[3] 秦光明[2] 

机构地区：[1]浙江大学医学院附属第二医院麻醉科,杭州市310009 [2]浙江大学医学院附属第二医院检验科,杭州市310009 [3]浙江大学医学院卫生检验中心

出　　处：《中华急诊医学杂志》2007年第1期50-53,共4页Chinese Journal of Emergency Medicine

基　　金：浙江省卫生厅科研项目（2005B078）

摘　　要：目的 观察体外循环心内直视手术围术期乌司他丁对S100β蛋白及肿瘤坏死因子-α（TNF-α）表达的影响。方法 30例择期心内直视手术患者随机分成两组：乌司他丁组（U组）和生理盐水对照组（C组），每组15例。U组于麻醉诱导后，体外循环前用微量泵输注溶于50ml生理盐水的乌司他丁（1万U／kg），体外循环（CPB）开始时再将乌司他丁（1万U／kg）加入体外循环机预充液中。C组用等体积的生理盐水。分别于CPB开始后15min（T1）、CPB结束时（T2）、CPB结束后2h（T3）、24h（T4）时点从颈内静脉采血，分别测定S100β蛋白和，TNF-α的水平。结果 与C组比较，T1和T4时点无统计学意义（P〈0．05），U组S100β和，TNF-α含量T2时点明显降低（P〈0．01）；T3时点也降低（P〈0．05）。两组T2、T3、T4时S100β水平均高于T1时点（P〈0．01）。C组T2、T3时TNF-α水平明显高于T1时点（P〈0．01）；U组各时点，TNF-α浓度之间差别无统计学意义（P〉0．05）。结论 体外循环心内直视手术围术期乌司他丁可减少TNF-α炎性因子的产生，并降低血浆中脑损伤的生化标志物S100β蛋白的表达水平。Objective To investigate the effect of ulinastatin on expression of S100β protein and TNF-α in patients undergoing open-heart surgery with cardiopulmonary bypass. Method Thirty adult patients undergoing selective open-heart surgery with eardiopulmonary bypass were randomly divided into two groups （15 in each group）： ulinastation （U） and control （C） group. In group U, patients received 10 000U/kg ulinastain after induction of anesthesia and before CPB. Another 10 000U/kg ulinastain was added to the priming solution at the beginning of the CPB. In group C the patients received normal saline instead of ulinastain. Blood sampleswere taken from internal jugular vein at 15 minutes after initiation of CPB （T1）, at the end of CPB （T2 ）, at 2 hours （T3） and 24 hours （T4） after the end of CPB for determination of plasma S100β protein and TNF-α levels. Results Plasma levels of S100β protein and TNF-α in group U were significantly lower than those in group C at T2 （ P 〈 0.01 ） and T3 （ P 〈 0.05） . There was no difference in both groups at T1 and T4 （ P 〉 0.05 ）. The plasma level of S100β protein significantly increased at T2 to T4 as compared to the baseline value at T1 in both groups （ P 〈 0.01）. In group C, TNF-α levels significantly increased at T= and T3 as compared to the baseline value at T1 （P 〈0.01）. There was no significant change in the expression of TNF-α in group U （P 〉 0.05）. Conclusions Ulinastatin could decrease the production of TNF-α, and attenuate the expression of S100β protein in plasma.

关 键 词：心肺转流术 胰蛋白酶抑制剂 S100Β蛋白 肿瘤坏死因子 

分 类 号：R686[医药卫生—骨科学]