抑肽酶和乌司他丁在体外循环中抗炎作用的比较  

Comparative study on ulinastatin and aprotinin on anti-inflammatory in patients undergoing extracorporeal circulation

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

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

出　　处：《第三军医大学学报》2009年第24期2490-2492,共3页Journal of Third Military Medical University

摘　　要：目的比较抑肽酶和乌司他丁在心脏手术体外循环(extracorporeal circulation,ECC)中的抗炎作用。方法选择60例心脏瓣膜置换手术患者,ASAⅡ～Ⅲ级,按随机数字表法分为乌司他丁组(U组)、抑肽酶组(A组)和空白对照组(C组),每组20例。于ECC前15min(T1)、开放升主动脉后10min(T2)、ECC结束后30min(T3)、ECC结束后60min(T4)4个时点取颈内静脉血测定下列指标:血浆IL-6、IL-8、IL-10及肿瘤坏死因子-α(TNF-α)浓度。分析3组各时点炎性因子的变化。结果3组血浆IL-6、IL-8、IL-10、TNF-α浓度在T2、T3、T4时点均明显高于T1时点(P<0.01);血浆IL-6、IL-8、TNF-α浓度在T2、T3、T4时点U组明显低于A、C组(P<0.05,P<0.01),A组明显低于C组(P<0.05);血浆IL-10浓度在T2、T3、T4时点U组、A组明显高于C组(P<0.05,P<0.01),U组明显低于A组(P<0.05)。结论乌司他丁和抑肽酶在ECC中都能抑制炎性因子的产生,并可上调抗炎因子表达。乌司他丁在抑制炎性因子的产生方面强于抑肽酶,而抑肽酶上调抗炎因子表达的作用优于乌司他丁。两者都可有效抑制ECC诱发的炎性反应。Objective To compare the effects of aprotinin and ulinastatin on antai-inflammatory in patients who undergoing cardiac valve replacement with extracorporeal circulation （ECC）. Methods Sixty ASA Ⅱ to m patients who underwent cardiac vavle replacement from June 2006 to March 2008 were randomly divided into 3 groups： ulinastatin group （group U, n = 20）, aprotinin group （group A, n = 20） and control group （group C, n = 20）. Half dose of ulinastatin （2 x l04 U/kg） and aprotinin （56 U/kg） was given to corresponding groups 10 min before ECC, and the left half was added into priming solution, and control groups received normal saline at the same volume. The intravenous blood samples were taken from 15 min before ECC （ T1 ）, 10 min after opening ascending aorta （T2）, 30 rain after discontinuation of ECC （T3） and 60 rain after discontinuation of ECC （T4） , and the plasma concentrations of IL-6, IL-8, IL-10 and TNF-α were detected to ana- lyze the changes of the inflammatory factors in each group at 4 time points. Results The plasma concentrations of IL-6, IL-8, IL-10 and TNF-α were significantly higher at time points T2, T3 and T4 than at T1. The plasma concentrations of IL-6, IL-8 and TNF-α at time points T2, T3 and T4 were significantly lower in group U than group A and group C （P 〈 0.05,0.01 ） , and these concentrations in Group A were lower than in group C （P 〈0. 05）. The plasma concentration of IL-10 at time points T2, T3 and T4 in group U and group A were significantly higher than in group C （P 〈 0.05, 0. 01 ） , with the former group significantly lower than the later （P 〈0.05）. Conclusion Ulinastatin and aprotinin inhibits the inflammatory factors induced by ECC, and improves the expressions of anti-inflammatory factors. Ulinastatin is more effective than aprotinin in inhibiting the inflammatory factors. However, aprotinin is more effective than ulinastatin in upregulating the expressions of anti-inflammatory factors. Both of them can effectively

关 键 词：体外循环 乌司他丁 抑肽酶 炎性因子 

分 类 号：R654.1[医药卫生—外科学] R969[医药卫生—临床医学]