盐酸戊乙奎醚对体外循环下法洛四联症根治术患儿心肌TLR4/NF-κВ信号通路的影响  

Effect of penehyclidine hydrochloride on TLR4/NF-κВ signaling pathway in myocardium of pediatric patients undergoing radical correction of tetralogy of Fallot with cardiopulmonary bypass

作　　者：郎志斌[1] 邱林[1] 赵亮[1] 张加强[1] 彭帮田[2] 赵晖[1] 

机构地区：[1]郑州大学人民医院麻醉科,450003 [2]郑州大学人民医院心外科,450003

出　　处：《中华麻醉学杂志》2017年第4期411-416,共6页Chinese Journal of Anesthesiology

摘　　要：目的评价盐酸戊乙奎醚对体外循环（CPB）下法洛四联症根治术患儿心肌Toll样受体4（TLR4）/NF-κB信号通路的影响。方法择期行CPB下法洛四联症根治术的患儿100例，性别不限，年龄5个月～3岁，BMI为13.9～16.0 kg/m^2，ASA分级Ⅱ或Ⅲ级，NYHA心功能分级Ⅱ或Ⅲ级，左室射血分数〉50%，采用随机数字表法分为2组（n＝50）：盐酸戊乙奎醚组（P组）和对照组（C组）。P组于颈内静脉穿刺成功后即刻静脉注射盐酸戊乙奎醚0.04 mg/kg，C组于相同时点静脉注射等容量生理盐水。于麻醉诱导前（T0）、诱导后10 min（T1）、复温至36 ℃时（T2）、CPB停机1 h（T3）、术毕（T4）及术后24 h（T5）时，取静脉血标本，采用ELISA法检测血浆TNF-α、IL-6、IL-8和cTnT浓度。于打开心包时及主动脉开放后1 h时取右心耳组织，进行心肌病理学观察，采用Western blot法和RT-PCR法分别测定心肌活化NF-κВ、NF-κВ mRNA和TLR4及其mRNA的表达水平。结果与C组比较，P组T2～T5时血浆TNF-α、IL-6和IL-8浓度及血浆cTnT浓度降低，主动脉开放后1 h时心肌活化NF-κВ、NF-κВ mRNA、TLR4及其mRNA表达下调（P〈0.05），心肌病理学损伤减轻。 结论盐酸戊乙奎醚减轻CPB下法洛四联症根治术患儿炎症反应的机制与抑制TLR4/NF-κВ信号通路激活有关。Objective To evaluate the effect of penehyclidine hydrochloride on Toll-like receptor 4（TLR4）/nuclear factor kappa B（NF-κB）signaling pathway in the myocardium of pediatric patients undergoing radical correction of tetralogy of Fallot with cardiopulmonary bypass（CPB）.Methods One hundred pediatric patients of both sexes, aged 5 months-3 yr, with body mass index of 13.9-16.0 kg/m^2 of American Society of Anesthesiologists physical status Ⅱ or Ⅲ（New York Heart Association classification Ⅱ or Ⅲ）, with the left ventricular ejection fraction〉50%, scheduled for elective radical correction of tetralogy of Fallot with CPB, were divided into 2 groups（n=50 each）using a random number table： penehyclidine hydrochloride group（group P）and control group（group C）. Penehyclidine hydrochloride was intravenously injected at a dose of 0.04 mg/kg immediately after successful internal jugular vein puncture in group P, and the equal volume of normal saline was given instead at the same time in group C. Before anesthesia induction, at 10 min after induction, after re-warming to 36 ℃, at 1 h after termination of CPB, at the end of surgery and at 24 h after surgery, venous blood samples were collected to detect the concentrations of tumor necrosis factor-alpha, interleukin-6（IL-6）, IL-8 and cardiac troponin T in plasma（by enzyme-linked immunosorbent assay）. Myocardial specimens were obtained from the right auricular appendage after opening of pericardium and at 1 h after aortic unclamping for microscopic examination and for determination of activated NF-κВ and TLR4 protein and mRNA expression（by Western blot and real-time polymerase chain reaction, respectively）.Results Compared to group C, the concentrations of plasma tumor necrosis factor-alpha, IL-6, IL-8 and cardiac tropnin T were significantly decreased after re-warming to 36 ℃, at 1 h after termination of CPB, at the end of surgery and at 24 h after surgery, the expression of activated NF-κВ and TLR4 protein and mRNA was dow

关 键 词：胆碱能拮抗剂 心肺转流术 法乐四联症 Toll样受体4 NF-κB 儿童 

分 类 号：R726.5[医药卫生—儿科]