乌司他丁对心肺转流心内直视手术患者围术期脑损伤的影响  

Effect of ulinastatin on perioperative cerebral injury in open heart surgery with cardiopulmonary bypass

作　　者：张秀来[1] 周海燕[1] 王屹[1] 彭全民[1] 叶怀庄[3] 杨小锋[2] 

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

出　　处：《中华创伤杂志》2007年第6期432-435,共4页Chinese Journal of Trauma

基　　金：浙江省卫生厅科研资助项目（2005B078）

摘　　要：目的 观察乌司他丁对心肺转流心内直视手术患者围术期脑损伤的影响及其可能机制。方法 30例择期心肺转流心内直视手术患者随机分成两组（各15例）：乌司他丁组和对照组。乌司他丁组于麻醉诱导后、心肺转流前将乌司他丁（1万U／kg）溶于50ml等渗盐水中用微泵泵人，心肺转流开始时再将乌司他丁（1万U／kg）预充加入心肺转流机内。对照组用等容量的等渗盐水替代。于心肺转流开始即刻、心肺转流结束后10min、4，24h4个时间点采桡动脉血4ml，分别测定血浆TNF-α、IL-6、IL-8、神经元特异性烯醇化酶（NSE）、S100β蛋白的浓度。结果组内比较，两组患者在心肺转流结束后10min-24hTNF-α、IL-6、IL-8、NSE及S100β的浓度均明显升高（P〈0．05或0．01）；与对照组比较，乌司他丁组患者TNF—α、IL-6、IL-8的浓度10min-24h均降低（P〈0．05或0．01），NSE及S100β浓度10min-4h均降低（P〈0．01）。结论 乌司他丁可以减轻心肺转流心内直视手术患者围术期的脑损伤，其可能机制主要是抑制促炎细胞因子的产生。Objective To investigate the effect of ulinastatin on perioperative cerebral injury in patients undergoing open heart surgery with cardiopulmonary bypass （CPB） and explore the possible mechanism. Methods A total of 30 adult patients undergoing selective open heart surgery with cardiopulmonary bypass were randomly allocated two groups （n = 15 each） ： Ulinastation group （Group U） and control group （Group C）. In Group U, the patients received ulinastain at 10 000 U/kg after induction of anesthesia and before CPB. Another ulinastain at 10 000 U/kg was given during CPB and added to the priming solution. In Group C, the patients received normal saline instead of ulinastain. Blood samples were obtained from radial artery at the initiation of CPB （ T1 ）, 10 rain （ T2 ）, 4 hours （ T3 ） and 24 hours （T4 ） after discontinuation of CPB for determination of plasma tumor necrosis factor（ TNF）, interleukin - 6 （IL-6） , IL-8, neuron-specific enolase （NSE） and S10013 protein levels. Results In both groups, plasma levels of TNF- IL-6, IL-8, NSE and S100β protein at T2.4 were all higher than at T1 （ P 〈0.05 or 〈0.01 ）. Plasma levels of TNF, IL-6, IL-8 in Group U were significantly lower than those in Group C at T2.4 （ P 〈0.01 or P 〈0.05 ） and the concentration of plasma NSE and S100 β protein decreased at T2 and T1 compared with Group C （ P 〈 0.01 ）. Conclusions Ulinastatin can decrease the perioperative cerebral injury in patients undergoing open heart surgery with CPB, which is possibly related to its inhibitive effect on production of inflammatory cytokines.

关 键 词：心肺转流术 脑损伤 胰蛋白酶抑制剂 神经组织蛋白质S100 神经元特异性烯醇化酶 

分 类 号：R686[医药卫生—骨科学]