乌司他丁对体外循环下瓣膜置换术患者TNF-α、MDA、PMN的影响  

The Influence of Ulinastatin on TNF-α,MDA,PMN during Cardio-pulmonary Bypass in Patients undergoing Heart Valve Replacement

作　　者：王虎[1] 吴继红[1] 邓丽[1] 张斌[1] 

机构地区：[1]宁夏医科大学附属医院心外科,银川750004

出　　处：《宁夏医科大学学报》2010年第4期494-497,共4页Journal of Ningxia Medical University

摘　　要：目的观察体外循环(cardiopulmonary bypass,CPB)下瓣膜置换围术期应用乌司他丁药物对肺保护作用。方法选择30例择期行心脏瓣膜置换术的患者随机分为乌司他丁组和对照组,每组15例。乌司他丁组给予乌司他丁12000 IU.kg-1于切皮后至CPB前缓慢静注半量,另半量加入预充液中随转机进入体内;对照组给予等量0.9%氯化钠注射液,用法同乌司他丁组。两组分别麻醉诱导后即切皮前(T1)、体外循环45min时(T2)、体外循环停机前5min(T3)、停机后6h(T4)及停机后24h(T5)5个时间点,T1～T3时间点即刻送动脉血检测中性粒细胞(PMN)值;分离血清检测T1～T3时点丙二醛(MDA)浓度和T1～T5时点TNF-α浓度。结果两组CPB开始后血清TNF-α、MDA、PMN浓度逐渐升高,CPB停机前5min三者血清浓度达到高峰,CPB后24 h TNF-α仍维持在很高的水平;乌司他丁组T3～T5时点的血清TNF-α浓度及T2～T3时点的血清MDA浓度、PMN值低于对照组相同时点值,差异有统计学意义(P<0.05)。结论乌司他丁可降低体外循环心脏瓣膜置换术CPB期间血液PMN及血清TNF-α、MDA的表达,起到肺保护的作用。Objective To observe the protective role of Ulinastatin in the patients with lung injury during perioperation of Heart valve replacement when undergoing Cardiopulmonary bypass. Methods 30 patients undergoing valve replacement were randomly allocated into Ulinastatin group and control group （ 15 cases in each group）. In Ulinastatin group,6000 IU · kg-1 of Ulinastatin were respectively injected before CPB and added in priming solution to accompanoy turnging point into vivo. In control group 0.9% NaCl solution was as a placebo. Serial blood samples were collected at the following intervals respectively ： After anesthesia induction （ T1 ） , 45rain after CPB （ T2 ） ,5rain before the end of CPB （ T3 ） and 6h （ T4 ） , and 24h after the end of CPB（T5 ）.We measured the serum levels of TNF - α by Elisa method at the time T1 - T5 and the malondialdehyde （MDA） by thiobarbituricacid chromatometry, and detected the polymorphonuclear leucocyte in the blood from T1 to T3. Results The serum levels of TNF-α, MDA and PMN gradually increased with time and reached the peak at 5min beforethe end of CPB. And the TNF - α still maintained a high level at 24h after the end of CPB. The serum levels of TNF - α in Ulinastatin group was significantly lower than that in control group （P 〈0.05 ） at the time T3 - T5. The serum levels of MDA and the PMN in Ulinastatin group was significantly lower than that in control group （P 〈 0.05 ） at the time T2 - T3. Conclusion Ulinastatin could reduce the release of TNF - α, and lipid peroxidation （MDA） and the PMN, so it can protect the injury of lung.

关 键 词：体外循环 TNF-Α 肺保护 乌司他丁 心脏瓣膜置换 

分 类 号：R654.1[医药卫生—外科学]