乌司他丁对成人先天性心脏病手术炎性反应的影响  

Effects of Ulinastatin on Systemic Inflammatory Response in Adult Patients With Congenital Heart Disease Undergoing Open-Heart Surgery

作　　者：向强[1] 杨小文[1] 董爱萍[1] 王荣[1] 王力甚[1] 

机构地区：[1]华中科技大学同济医学院附属荆州医院麻醉科,湖北荆州434020

出　　处：《中国体外循环杂志》2007年第1期17-19,共3页Chinese Journal of Extracorporeal Circulation

摘　　要：目的探讨乌司他丁应用于成人先天性心脏病手术中对患者部分炎性介质的影响。方法成人先天性心脏病患者40例(其中室间隔缺损27例、房间隔缺损13例),随机分为乌司他丁组(U组)和对照组(C组),每组20例。乌司他丁组在麻醉诱导前和体外循环(extracorporeal circulation,ECC)开始时各给予乌司他丁10000U/kg,对照组行常规ECC。分别在麻醉诱导前(T1)、ECC结束时(T2)、术毕6 h(T3)、24 h(T4)采集血标本,检测血清中肿瘤坏死因子(TNF-α)、白细胞介素2(IL-2)和白细胞介素10(IL-10)浓度。结果ECC结束后两组TNF-α、IL-2、IL-10均有明显增高;U组TNF-α、IL-2在T2、T3、T4时点增值较C组为低(P<0.05,<0.01),而IL-10在T2、T3、T4时点增值则较C组为高(P<0.05,<0.01)。结论乌司他丁应用于成人先天性心脏病手术中可减少TNF-α、IL-2、等促炎细胞因子的释放,同时可促进抑炎细胞因子IL-10的分泌,从而减轻ECC炎性反应。OBJECTIVE To investigate the effects of ulinastatin on systemic inflammatory response in adult patients with congenital heart defect undergoing open - heart surgery. METHODS Forty ASA Ⅱ-Ⅲ patients with congenital heart disease（CHD） scheduled for elective open -heart surgery were randomly divided into two groups： ulinastatin group （U） and control group（C） ,20 cases in each group. In group U ulinastatin 10000U/kg was injected by intravenous before anesthesia induction and another 10000U/kg was added to the priming fluid. Blood samples were taken from artery at the time before induction（T1 ）,at the end of extracorporeal cireulation（ECC）（T2）, at 6hours after operation（T3 ） and 24hours postoperative（T4） for detection serum levels of IL -2, IL - 10 and TNF -α. RESULTS Compared with group C, the serum lever of IL-2 and TNF-α in group U increased insignificantly,but the serum lever of IL -10 increased significantly. CONCLUSION The use of ulinastatin in ECC of adult patients with congenital heart defect undergoing open - heart surgery can inhibit the expression of some pro - inflammatory cytokines such as IL - 2 and TNF - α, and the expression of anti - inflammatory cytokine IL - 10 may be accelerated, so that it relieve the systemic inflammatory response induced bv ECC.

关 键 词：乌司他丁 体外循环 细胞因子 先天性心脏病 

分 类 号：R614[医药卫生—麻醉学] R654.2[医药卫生—外科学]