乌司他丁和抑肽酶对体外循环小儿炎性反应及心肌损伤的影响  

Effects of ulinastatin and aprotinin on inflammatory response and myocardial injury in children undergoing cardiopulmonary bypass

作　　者：赵琦峰[1] 胡型锑[1] 杜杰[1] 吴国伟[1] 

机构地区：[1]温州医学院附属第二医院心胸外科,325027

出　　处：《中华麻醉学杂志》2007年第3期199-203,共5页Chinese Journal of Anesthesiology

基　　金：浙江省温州市科技计划项目（Y2003A034）

摘　　要：目的研究乌司他丁和抑肽酶对体外循环（CPB）小儿炎性反应及心肌损伤的影响。方法选择拟行CPB的先天性心脏病患儿90例,随机分成6组,每组15例：对照组（C组,不使用乌司他丁及抑肽酶）、小剂量乌司他丁组（UL组,乌司他丁1万U/kg）、大剂量乌司他丁组（UH组,乌司他丁2万U/kg）、小剂量抑肽酶组（AL组,抑肽酶7．5万KIU/kg）、大剂量抑肽酶组（AH组,抑肽酶15万KIU/ kg）、小剂量乌司他丁复合小剂量抑肽酶组（UL＋AL组,乌司他丁1万U/kg＋抑肽酶7．5万KIU/kg）。乌司他丁或/和抑肽酶按各组要求剂量在转机前一次性加入预充液中。于CPB前（T1）、升主动脉开放5 min（T2）、CPB结束后30 min（T3）、4 h（T4）抽取动脉血,测定血浆IL-6、IL-8、IL-10、TNF-α、cTnI浓度及CK-MB活性,记录术后辅助通气时间、24 h引流量、心脏复跳情况及围术期多巴胺使用情况。结果与C组比较,在T2～T4时,UH组、AH组、UL＋AL,组血浆IL-6、IL-8、TNF-α、cTnI浓度及CK-MB活性降低;AH组、UL＋AL组IL-10增高（P＜0．05）;UL＋AL组心脏自动复跳率（100％）增高,血管活性药物使用率较低,术后辅助通气时间较短（P＜0．05）;AH组术后出血量较少（P＜0．05）。结论大剂量乌司他丁、大剂量抑肽酶及小剂量乌司他丁复合小剂量抑肽酶,均可通过抑制CPB炎性反应、减轻小儿心肌损伤,小剂量乌司他丁复合小剂量抑肽酶效果更佳。Objective To investigate the effects of two protease inhibitors （ulinastatin and aprotinin） on inflammatory response and myocardial injury in children undergoing cardiopulmonary bypass （CPB）. Methods Ninety children with atrial septal defect, ventricular septal defect or patent ductus arteriosus aged 1-4yr undergoing elective heart surgery under CPB were randomly divided into 6 groups （ n = 15 each） ： group Ⅰ control （C） ; group Ⅱ ulinastatin 10 000 U/kg （ UL ） ; group Ⅲ ulinastatin 20 000 U/kg （ UH ） ; group Ⅳ aprotinin 75 000 KIU/kg （AL） ; group Ⅴ aprotinin 150 000 KIU/kg （ AH ） and group Ⅵ UL ＋ AL. Ulinastatin and apretinin were added to the priming solution before CPB. Anesthesia was induced and maintained with fentanyl, midazolam, propofol infusion and isoflurane inhalation. Blood samples were taken before CPB （T1, baseline）, 5 min after aortic unclamping （T2）, 30 min （T3 ） and 4 h （T4） after termination of CPB for determination of plasma concentrations of IL-6, IL-8, IL-10, TNF-α, cTnI and CK-MB activity. Results The six groups were comparable with respect to M/F sex ratio, age, body weight and CPB time. The plasma cytokine and cTnI concentrations and CK-MB activity were significantly increased at T2-4 as compared with the baseline values before CPB （T1 ） in all 6 groups. The plasma IL-6, IL-8, TNF-α and cTnI concentrations and CK-MB activity were significantly lower at T2-4 in group UH （Ⅲ） ,group AH （Ⅴ） and group UL ＋ AL（Ⅵ） than in control group. The plasma IL-10 concentration was significantly higher at T2-4 in group As （Ⅴ） and group UL ＋ AL （Ⅵ） than in control group . The duration of mechanical ventilation was significantly shorter in group AL ＋ UL （group Ⅵ ） than in control group. The postoperative blood loss was significantly less in group As than in control group. Conclusion Ulinastatin and apretinin can both effectively decrease inflammatory response and protect myocardium from I/R injury i

关 键 词：胰蛋白酶抑制剂 抑肽酶 心肺转流术 炎症 心肌再灌注损伤 

分 类 号：R686[医药卫生—骨科学]