乌司他丁对犬体外循环心内直视手术胰岛素抵抗的影响  

Effect of ulinastatin on insulin resistance induced by cardiac surgery on mongrel dogs involving cardiopulmonary bypass

作　　者：周涛[1] 李遂宁 向道康[1] 刘波[2] 

机构地区：[1]贵州省人民医院心外科,贵阳550002 [2]贵州省人民医院内分泌科,贵阳550002

出　　处：《中华实验外科杂志》2016年第9期2166-2169,共4页Chinese Journal of Experimental Surgery

基　　金：贵州省自然科学基金（黔科合J字[2013]2175号）;贵州省科技厅-贵州省人民医院联合基金项目（黔科合LS字[2012]012号）

摘　　要：目的 观察乌司他丁对犬体外循环（CPB）心内直视手术胰岛素抵抗的影响.方法 30条雄性杂交犬,按随机数字表分为对照组（术中未使用乌司他丁）、U1组（体外循环预充液中加入1万U/kg乌司他丁）和U2组（预充液中加入2万U/kg乌司他丁）.分别于手术前、麻醉诱导后、CPB开始30 min、停CPB时、CPB后2h和术后24、72、120 h采集血样,观察空腹血糖、胰岛素和肿瘤坏死因子-α（TNF-α）浓度变化,并计算胰岛素抵抗指数.结果 空腹血糖、胰岛素抵抗指数变化：对照组在CPB开始30 min分别为（11.12±2.45） mmol/L、3.32±0.44]直至术后72h[（6.01±0.65） mmol/L、1.71±0.28]较CPB前升高,U1、U2组CPB开始30 min[（9.12±2.09） mmol/L、2.47±0.39和（8.42±1.95） mmol/L、2.51±0.31]至术后24 h[（10.22±2.04） mmol/L、2.32±0.35和（8.89±1.56） mmol/L、2.44±0.41]较CPB前升高,U1、U2组在CPB开始30 min至术后72 h时低于对照组（P＜0.05）.3组犬胰岛素水平和TNF-α浓度在CPB开始30 min至术后24h较CPB前升高,但U1、U2组浓度较对照组低（P＜0.05）,U1和U2组各时间点胰岛素水平差异无统计学意义（P＞0.05）,U2组TNF-α 浓度在停CPB时、CPB后2h较U1组低[（32.55±7.59） mmol/L比（48.24±8.22） mmol/L,（47.37±8.59） mmol/L比（66.51±10.53） mmol/L] （P ＜0.05）.结论 乌司他丁可以缓解犬CPB手术后的胰岛素抵抗,该作用与乌司他丁减轻机体炎性反应有关。Objective To investigate the effect of ulinastatin on insulin resistance induced by cardiac surgery with cardiopulmonary bypass （CPB）.Methods Thirty mongrel dogs undergoing cardiac surgery were divided into three groups：control group,U1 group （10 000 U/kg ulinastatin was added into circuit priming）,and U2 group （20 000 U/kg ulinastatin was used）,10 dogs in each group.In all groups,blood samples withdrawn at different time points （before surgery,before the CPB,30 min after the start of CPB,end of CPB,2 h after weaning from CPB,24,72 and 120 h after surgery） were assayed for fasting plasma glucose,fasting insulin,and tumor necrosis factor-alpha （TNF-α）.In addition,homeostatic model assessment of insulin resistance （HOMA-IR） was calculated.Results As compared with baseline values,plasma levels of fasting plasma glucose and HOMA-IR were increased from 30 min after the start of CPB [（11.12±2.45） mmol/L,3.32 ±0.44 respectively] to 72 h after surgery [（6.01 ±0.65）mmol/L,1.71 ± 0.28 respectively] in control group,and in U1 group and U2 group,those indicators were increased from 30 min after CPB commencement [（9.12 ± 2.09） mmol/L,2.47± 0.39 and （8.42 ± 1.95） mmol/L,2.51 ± 0.31] to 24 h after surgery [（10.22 ± 2.04） mmol/L,2.32 ± 0.35 and （8.89 ± 1.56） mmol/L,2.44 ±0.41].Compared to control group,the indicators were lower in U1 group and U2 group from 30 min after the start of CPB to 72 h after surgery （P 〈 0.05）.As compared with baseline values,levels of fasting insulins and TNF-α in all groups were increased from 30 min after CPB commencement to 24 h after surgery,and increasing degrees were higher in contrl group than in U1 group and U2 group （P 〈0.05）.The increasing degrees of TNF-α were lower in U2 group than in U1 group at the end of CPB and 2 h after surgery [（32.55 ± 7.59） mmol/L vs.（48.24 ± 8.22） mmol/L,and （47.37 ± 8.59） mmoL/L vs.（66.51 ± 10.53） mmol/L] （P〈0.05）.Conclusion Ulinastatin can decrease insulin resis

关 键 词：体外循环 胰岛素抵抗 乌司他丁 

分 类 号：R654.1[医药卫生—外科学]