乌司他丁后处理及其联合预先给药对CPB下心脏瓣膜置换术患者心肌炎性反应的影响  

Effects of ulinastatin postconditioning and combining ulinastatin postconditioning with pretreatment on myocardial inflammatory response in patients undergoing valve replacement under CPB

作　　者：王焰斌[1] 杨建安[2] 王小雷[1] 黄志勇[1] 翟宇佳[1] 程毅坚[1] 叶晓青[1] 杨晓涵[2] 王毅[3] 

机构地区：[1]深圳市孙逸仙心血管医院麻醉科,518020 [2]深圳市孙逸仙心血管医院心脏外科,518020 [3]深圳市孙逸仙心血管医院检验科,518020

出　　处：《中华麻醉学杂志》2011年第11期1316-1319,共4页Chinese Journal of Anesthesiology

基　　金：2010年深圳市科技计划项目（201002118）;2010年天普研究基金（01200903）

摘　　要：目的评价乌司他丁后处理及其联合预先给药对CPB下心脏瓣膜置换术患者心肌炎性反应的影响。方法择期行CPB下心脏瓣膜置换术患者80例，性别不限，年龄21—59岁，心功能分级Ⅱ或Ⅲ级。采用随机数字表法，将患者随机分为4组（n=20）：生理盐水对照组（C组）、乌司他丁预先给药组（U1组）、乌司他丁后处理组（U1组）和乌司他丁预先给药联合后处理组（U3组）。U1组于气管插管后至升主动脉阻断前10min经中心静脉输注乌司他丁500～1000U·kg^-1·min^-1。（剂量20000U／kg）；U2组于主动脉开放前5—7min经主动脉根部灌注乌司他丁4000～5000U·kg^-1·min^-1（剂量10000U／kg）；U，组进行乌司他丁预先给药联合后处理；C组给予等容量生理盐水。分别于升主动脉阻断前10min（T1）、升主动脉阻断后40min（T1）、主动脉开放后45min（T3）和术毕（T4）时采集动脉血样，测定血浆IL-10、IL-1、IL-6和TNF—α的浓度，并进行中性粒细胞（PMN）计数。于主动脉开放后45min时取右心耳组织，采用免疫组化法测定IL-6和IL-1β的表达。结果与C组比较，U1组、U2组和U1组血浆IL-10浓度升高，血浆IL-1、IL-6、TNF—α的浓度和PMN计数降低，心肌组织IL-1β和IL-6表达下调（P〈0．05）；与U1组和U2组比较，U3组T2～4时血浆IL-10浓度升高，血浆IL-1、IL-6、TNF—α的浓度和PMN计数降低，心肌组织IL-1β和IL-6表达下调（P〈0．05）。结论乌司他丁后处理可抑制CPB下心脏瓣膜置换术患者心肌炎性反应，联合预先给药时其效应增强。Objective To investigate the effects of ulinastatin postconditioning and combining ulinastatin postconditioning with pretreatment on myocardial inflammatory response in patients undergoing cardiac valve replacement under CPB. Methods Eighty NYHA class Ⅱ orⅢ patients of both sexes aged 21-59 yr undergoing cardiac valve replacement under CPB were randomly divided into 4 groups （ n = 20 each） ： group control （ group C） ; group ulinastatin pretreatment （group U1 ） ; group ulinastatin postconditioning （group U2 ） and group ulinastatin pretreatment and posteonditioning combined （group U3 ） . Ulinastatin 20 000 U/kg was infused via central vein at 500-1000 U·kg^-1·min^-1 after tracheal intubation until 10 rain before cross-clamping of ascending aorta in groups U1 and U3 . Ulinastatin 10 000 U/kg was infused into root of aorta at 4000-5000 U·kg^-1·min^-1 at 5-7 min before declamping of aorta in groups U2 and U3. Blood samples were obtained from radial artery before cross clamping of ascending aorta, at 40 rain after aortic cross-clamping, at 45 min after deelamping of aorta （T3） and at the end of operation for polymorphonuelear leukocyte （PMN） eount, routine analysis of blood and determination of plasma eoneentrations of IL-10, TNF-α, IL-1 and IL-6 （by ELISA）. Myocardial specimens were obtained at 45 min after declamping of aorta for determination of IL-1β and IL-6 expression by immune-histochemistry. Results Ulinastatin pretreatment and/or postconditioning signifieantly increased plasma IL-10 eoneentration and decreased plasma IL-1, IL-6, TNF-α concentrations and PMN count and myocardial IL-1β and IL-6 expression in groups U1, U2 and U3 as compared with group C. Plasma IL-10 concentration was significantly higher and plasma IL-1, IL-6 and TNF-α coneentrations, PMN count and myocardial IL-1β and IL-6 expression were lower in group U3 than in groups Ul and U2 . Conclusion Uhnastatin posteonditioning ean inhibit myocardial imilammatory response in patients undergoing valve re

关 键 词：胰蛋白酶抑制剂 炎症 心肺转流术 心脏瓣膜假体植入 后处理 

分 类 号：R654.2[医药卫生—外科学]