盐酸戊乙奎醚对体外循环心脏手术患者全身炎症反应的影响  

Effects of penehyclidine hydrochloride on systemic inflammatory reaction in patients undergoing cardiac surgery with cardiopulmonary bypass

作　　者：黎笔熙[1] 朱水波[2] 殷桂林[2] 张晓明[2] 程旺生[1] 程大新[1] 陶军[1] 

机构地区：[1]广州军区武汉总医院麻醉科,武汉430070 [2]广州军区武汉总医院心胸外科

出　　处：《中国体外循环杂志》2016年第4期222-225,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的探讨盐酸戊乙奎醚(PHC)对体外循环(CPB)心脏手术患者术后全身炎症反应的影响。方法择期体外循环下行心脏手术患者40例,心功能NYHA分级II^III级,按照随机数字法分为观察组和对照组,每组20例。观察组患者麻醉诱导前静脉注射PHC 0.03 mg/kg;对照组患者相同时间点注射等容量的生理盐水。分别于麻醉诱导前(T_0)、手术结束时(T_1)、手术后6 h(T_2)、12 h(T_3)、24 h(T_4)等5个时间点测定血浆IL-8、T_NFα和NF-κB等水平。记录麻醉药物用量;记录患者气管导管留置时间、ICU住院时间、术后住院时间等临床指标。结果 T_1至T_4两组血浆IL-8和T_NFα浓度显著升高(P<0.05),观察组IL-8和T_NFα浓度显著低于对照组(P<0.05)。T_1至T_4两组血浆NF-κB浓度显著升高(P<0.05),观察组NF-κB浓度显著低于对照组(P<0.05)。观察组患者术后留置气管导管时间、ICU住院时间和术后总住院时间均小于对照组,但两组间差异无统计学意义(P>0.05)。结论 PHC对CPB下心脏手术患者的系统性的炎症反应具有一定的抑制效应,其机制与其调控NF-κB信号通路的活性、减少IL-8和T_NFα等炎性介质的释放有关。Objective To investigate effects of penehyclidine hydrochloride （PHC）on systemic inflammatory reaction in pa- tients undergoing cardiac surgery with cardiopulmonary bypass （CPB）. Methods Forty patients undergoing cardiac surgery with car- diopulmonary bypass were enrolled in the study. All patients were randomly divided into trial group and control group （twenty in each group）. Patients in trial groupreceived an intravenous injection of 0.03 mg/kg PHC before anesthesia induction and those in control group were given the same volume of normal saline. Blood samples were collected at the following time points ： before anesthesia induc- tion （TO）, the end of the operation （T1）, 6 hours （T2）, 12 hours （T3） and 24 hours postoperatively （T4） for the measurement of IL-8, TNFα and NF-κB. The outcomes included duration of intubation （DOI）, length of intensive care unit stay （LOI） and length of hospital stay after the surgery （LOH）. Results The plasma levels of IL-8 and TNFα increased significantly from T1 to T4 in both groups, and those in trial group were statistical lower than control group from T1 to T4 （ P 〈0.05）. The plasma level of NF-κB increased siguifieantly from T1 to T4 in both groups, and those in trial group were lower than control group from T1 to T4 （ P 〈0.05）. The DOI, LOI and LOH in trial groupwere shorter than control group, but there were no statistically significant between two groups （ P 〉0.05）. Conclusion PHC inhibits systemic inflammatory response in patients undergoing cardiopulmonary bypass, and its mecha- nisms is relevant to the regulation of NF-κB signal way on the production of proinflammatory eytokinesas,like IL-8 and TNFα.

关 键 词：体外循环 心脏手术 全身炎症反应 盐酸戊乙奎醚 

分 类 号：R614[医药卫生—麻醉学]