乌司他丁对心脏瓣膜置换术患者体外循环期间全身炎性反应的影响  

Effects of ulinastatin on systemic inflammatory response in patients undergoing cardiac valve replacement with cardiopulmonary bypass

作　　者：赵艳[1] 张俊 彭星[1] 余红岚[2] 孔航[1] 史丽绢[1] 陈茜[1] 

机构地区：[1]贵阳市第一人民医院麻醉科,550002 [2]贵阳市第一人民医院检验科,550002

出　　处：《中华麻醉学杂志》2009年第8期685-687,共3页Chinese Journal of Anesthesiology

摘　　要：目的探讨乌司他丁对心脏瓣膜置换术患者体外循环期间全身炎性反应的影响。方法拟行心脏瓣膜置换术的风湿性心脏病患者40例，性别不限，体重39～72kg，年龄27—44岁，ASAⅡ或Ⅲ级，随机分为2组（n=20）：对照组（C组）和乌司他丁组（U组）。U组于CPB前10min静脉注射乌司他丁1万U／kg，CPB预充液中加入1万U／kg，C组以等容量生理盐水替代乌司他丁。于CPB前15min（T1）、CPB10min（T2）、CPB结束后30min（T3）、60min（T4）时测定血浆白细胞介素6（IL-6）、IL-8、IL-10及肿瘤坏死因子α（TNF-α）的浓度。结果与C组比较，U组CPB期间和CPB结束后血浆IL-6、IL-8和TNF-α的浓度降低，IL-10浓度升高（P〈0．05或0．01）；与T1比较，T2,3时两组血浆IL-6、IL-8、IL-10、TNF-α的浓度升高（P〈0．01）。结论乌司他丁可减低心脏瓣膜置换术患者CPB期间促炎-抗炎反应失衡，减轻全身炎性反应。Objective To investigate the effects of ulinastatin on the systemic inflammatory response in the patients undergoing cardiac valve replacement with cardiopulmonary bypass （CPB）. Methods Forty ASA Ⅱ or Ⅲ patients of both sexes, aged 27-44 yr, weighing 39-72 kg, scheduled for cardiac vavle replacement, were randomly divided into 2 groups （ n = 20 each） ： control group （ group C ） and ulinastatin group （ group U）. Ulinastatin 10 000 U/kg was injected iv 10 min before CPB, and ulinastatin 10 000 U/kg was added to the priming fluid in group U, The equal volume of normal saline was given in stead of ulinastatin in group C. Venous blood samples were taken at 15 min before CPB （T1）, 10 min of CPB （T2）, and 30 and 60 min after termination of CPB （T3,4） for determination of the plasma concentrations of IL-6, IL-8, IL-10 and TNF-α. Results The plasma concentrations of IL-6, IL-8 and TNF-α were significantly lower and plasma IL-10 concentration was significantly higher during and after CPB in group U than in group C （P 〈 0.05 or 0.01）. The plasma concentrations of IL-6, IL-8, IL-10 and TNF-α were significantly higher in both groups at T2.3 than at T1 （ P 〈 0.01 ）. Conclusion Ulinastatin can ameliorate the unbalance between pro- and anti-inflammatory responses during CPB and reduce the systemic inflammatory response in the patients undergoing cardiac valve replacement.

关 键 词：胰蛋白酶抑制剂 全身炎症反应综合征 心肺转流术 心脏瓣膜假体植入 

分 类 号：R65[医药卫生—外科学]