乌司他丁对体外循环冠脉搭桥手术围术期炎症反应的影响

Effect of ulinastatin on perioperative inflammatory response to coronary artery bypass grafting with cardiopulmonary bypass

doi:
10.3969/j.issn.1672-7347.2010.02.003
摘要:
目的:探讨乌司他丁对体外循环冠脉搭桥手术(CABG)围术期炎症反应的影响.方法:择期行CABG患者40例,随机分为对照组(C组,n=20)和乌司他丁组(U组,n=20).U组于体外循环(CPB)前静脉滴注乌司他丁1.5×10~4 U/kg,C组于相同时间静脉滴注生理盐水.分别于麻醉诱导前(T1)、CPB1h(T2)、CPB后1h(T3)、CPB后24 h(T4)检测血浆肿瘤坏死因子(TNF-α)、白细胞介素(IL)-6、IL-10和中性粒细胞弹性蛋白酶(NE)的浓度.比较两组患者手术后的恢复情况.结果:与T1相比,2组患者在T2,T3,T4时点TNF-α,IL-6,IL-10及NE的浓度均明显升高((P<0.05);U组在T2,T3,T4的TNF-α,IL-6及NE浓度均明显低于C组(P<0.05),而IL-10的浓度明显高于C组(P<0.05).U组患者术后肺、肾及脑功能明显优于C组(P<0.05),心、肝功能及ICU停留时间无明显差异(P>0.05).结论:乌司他丁能够减轻体外循环冠脉搭桥手术围术期炎症反应,减少术后并发症.
Abstract:
Objective To determine the effect of ulinastatin on perioperative inflammatory response to coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Methods Forty patients undergoing CABG with CPB were randomly divided into 2 groups: a ulinastatin group (1.5×10~4 U/kg before CPB, n=20) and a control group (n=20). The inflammatory cytokines such as tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-10 and neutrophil elastase (NE) were measured before the anesthesia (T1), 1 h after the start of CPB (T2), 1 h after weaning of CPB (T3), and 24 h after weaning of CPB (T4). The postoperative organ dysfunction in the 2 groups was noted.Results The concentration of TNF-α, IL-6, IL-10, and NE at T2,T3, and T4 and increased more significantly than that at T1 in the 2 groups(P<0.05). The concentration of TNF-α, IL-6 and NE at T2, T3, and T4 in the ulinastatin group decreased more significantly than that in the control group (P<0.05), and IL-10 in the ulinastatin group increased at the same time. The postoperative complications of pneumonia, kidney and central nervous system in the ulinastatin group decreased more significantly than that in the control group (P<0.05). There was no significant difference in the postoperative cardio or liver complications and hours in the ICU between the 2 groups.Conclusion Administration of ulinastatin before CPB can decrease the inflammatory response and complication during CABG.
作者 周琪    王刚    高长青    陈婷婷
Author: ZHOU Qi    WANG Gang    GAO Changqing    CHEN Tingting
作者单位 解放军总医院心血管外科,北京,100853
刊 名: 中南大学学报(医学版)   ISTICPKU
Journal: JOURNAL OF CENTRAL SOUTH UNIVERSITY(MEDICAL SCIENCES)
年,卷(期) 2010, 35(2)
分类号 R9
关键词: 炎症反应 知识脉络    乌司他丁 知识脉络    体外循环 知识脉络    冠状动脉旁路移植术 知识脉络   
Keywords: inflammatory response    ulinastatin    cardiopulmonary bypass    coronary artery bypass grafting   
机标分类号 R65 R54
基金项目 全军医疗卫生基金
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