乌司他丁对婴幼儿体外循环炎性反应的影响  

Clinical Study of Ulinastatin on Inflammatory Response and Lung Protection During and after Cardiopulmonary Bypass in Infant

作　　者：李桂芬[1] 孙桂民[1] 高国栋[1] 李景文[1] 杨九光[1] 胡强[1] 

机构地区：[1]阜外心血管病医院体外循环科,北京100037

出　　处：《中国体外循环杂志》2003年第1期13-15,共3页Chinese Journal of Extracorporeal Circulation

摘　　要：目的　研究乌司他丁 (Ulinastatin)对婴幼儿体外循环炎性反应的影响及其肺保护作用。方法　选择 45例先天性心脏病患儿 ,随机分为 3组 ;对照组 (A组 ) ,B组 U TI 1万 U I/kg,C组 U TI 2万 UI/kg。分别于麻醉诱导后 (T1 ) ,开放升主动脉后 5 min(T2 ) ,CPB结束后 2 h(T3) ,6h(T4) ,和 2 4h(T5)各时点采集血样 ,检测血浆肿瘤坏死因子 -α(TNF-α) ,白细胞介素 - 6(IL - 6) ,白细胞介素 - 8(IL - 8)和白细胞介素 - 10 (IL - 10 ) ;分别于术后 2 h和 6h记录气道平均压 ,吸入氧浓度和动脉血气 ,计算肺泡氧合指数 (OI)。结果　血浆 IL - 6的水平在体外循环中及术后各时点 C组较 A组明显降低 (P<0 .0 5 ) ,IL - 10的浓度体外循环中及术后各时点 C组较 A组显著升高 (P<0 .0 5 ) ,TNF- a的浓度体外循环中 C组低于 A组 (P<0 .0 5 ) ,IL - 8的水平 3组各时点均无明显差异 (P>0 .0 5 )。OI C组与 A组相比差异显著 (P<0 .0 5 )。结论　 U TI 2万 U I/kg可抑制 IL - 6的释放 ,对 TNF-α有一定的抑制作用 ,使 IL - 10的释放明显上调。 U TI通过上调 IL - 10的抗炎作用和对炎性介质不同程度的抑制 ,可减轻体外循环后的炎性反应 。OBJECTIVE To investigate the effect of ulinastatin on inflammatory response and lung protection in infants undergoing cardiopulmonary bypass (CPB). METHODS Forty five infants with congenital heart disease, aged 0.5~3years, weight 7~14 kg, were randomly divided into three groups: group A(control); group B(receive ulinastatin 10 000 UI/kg); group C(receive ulinastatin 20 000 UI/kg). Blood samples were collected from central vein for the measurement of necrosis factor α(TNF α),interleukin 6(IL 6), 8(IL 8) and 10(IL 10) before CPB, at 5min after aortic declamping. and 2, 6, 24 hours after the termination of CPB. Alveolar oxygenation index(OI) were recorded at 2 and 6 hours after operation. RESULTS The plasma levels of IL 6 in group C decreased compared with group A(P<0.05); IL 10 in group C increased compared with group A(P<0.05); TNF α decreased in group C compared with group A(P<0.05) at 5 min after aortic declamping; OI in group C decreased significantly compared with group A. CONCLUSIONS Ulinastatin (20 000 UI/kg) can inhibit the inflammatory cytokine (IL 6, TNF α)release, stimulate the release of IL 10 and has a lung protective effect.

关 键 词：乌司他丁 炎性反应 体外循环 肺保护 婴幼儿 

分 类 号：R726.5[医药卫生—儿科]