乌司他丁预处理对深低温停循环主动脉手术患者脑缺血再灌注损伤的影响  

Effects of ulinastatin preconditioning on cerebral ischemia-reperfusion injury in patients undergoing operation on aor- ta with deep hypothermic circulatory arrest

作　　者：王焰斌[1] 杨建安[2] 陈伟新[2] 翟宇佳[1] 程毅坚[1] 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外科,518020 [3]深圳市孙逸仙心血管医院检验科,518020

出　　处：《中华胸心血管外科杂志》2013年第10期614-616,626,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨乌司他丁预处理对深低温停循环（DHCA）主动脉手术患者术中脑缺血再灌注损伤的影响。方法DHCA下行主动脉手术患者30例，其中男26例，女4例；年龄30～50岁。美国国立卫生研究院卒中量表（NIHSS）评分〈10分。随机分为2组（n=15）：生理盐水对照组（C组）、乌司他丁预处理组（U组）。U组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）；C组给予等容量生理盐水。分别于DHCA前5min（T1）、DHCA开始后15min（T2）、DHCA结束后15min（T3）采集颈内静脉血样，测定血清中星形胶质细胞S-100B蛋白（S-100β）、脑型肌酸激酶同工酶（CK-BB）、谷氨酸（Glutamme，Glu）、肿瘤坏死因子（TNF-α）、白细胞介素-1（IL-1）、白细胞介素-10（IL-10）、丙二醛（MDA）与超氧化物歧化酶（SOD）及转化生长因子-β1（TGF—β1）的水平。术后第2天行NIHSS评分。结果与C组比较，U组血浆S-100β、CK-BB、Glu、TNF-α、IL-1和MDA浓度水平降低，IL-10、SOD及TGF-β1水平升高，NIHSS评分降低（P〈0．05）。结论乌司他丁预处理可减轻深低温停循环下主动脉手术患者术中脑缺血再灌注损伤，其机制与抑制氧自由基生成有关。Objective To investigate effects of ulinastatin preconditioning on cerebral ischemia-reperfusion injury in pa- tients undergoing operation on aorta with deep hypothermic circulatory arrest. Methods 30 patients aged 30 - 50 with national institutes of health stroke scale（NIHSS） 〈 10 undergoing operation on aorta with deep hypothermic circulatory arrest ,were ran- domly divided into 2 groups （n = 15 ） ： normal saline control group （group C）, ulinastatin preconditioning group （group U）. in group U ,ulinastatin 20 000U/kg was infused via central vein at 500-1000 U . kg-1 . min-1 from after tracheal intubation, until 10 min before ascending aortic cross-clamping. In group C, same volume normal saline was infused instead of ulinastatin. Blood samples were taken from internal carotid vein at 5 rain before the beginning of deep hypothermic circulatory arrest（ Tl ）, 15 rain after the beginning of deep hypothermic circulatory arres（ T2 ） and 15 min after the end of deep hypothermic circulatory arrest（T3 ）for determination of plasma concentrations of S-10013, CK-BB , Glutamate（Glu） ,TNF-α,IL-1 ,IL-10,MDA,SOD and TGF-β1. Cerebral funcition was evaluated and scored using NIHSS at 2 day after operation. Results Plasma concentra- tions of S-100β, CK-BB , Glu, TNF-α,IL-1 and MDA were lower,the levels of SOD, IL-10 and TGF-β1 were higher, and the NIHSS score was lower in group U （ P 〈 0.05 ）. Conclusion Ulinastatin preconditioning can lighten cerebral ischemia-reper- fusion injury in patients undergoing operation on aorta with deep hypothermic circulatory arrest. The mechanism is involved in inhibit the formn of reactive oxygen free radical.

关 键 词：停循环 深低温 诱导 脑缺血 再灌注损伤 心脏心科手术 乌司他丁 

分 类 号：R654.2[医药卫生—外科学]