抑肽酶联合大剂量糖皮质激素在体外循环中的应用研究

Protective effect of combination of aprotinin and high dose glucocorticoid during cardiopulmonary bypass

目的 观察体外循环(CPB)中联合应用抑肽酶和大剂量糖皮质激素的临床应用效果。方法 将接受择期二尖瓣及主动脉瓣置换术(DVR)的患者80例随机分为4组:A组(对照组,n=20);B组(抑肽酶组,n=20);C组(糖皮质激素组,n=20);D组(抑肽酶及糖皮质激素联合应用组,n=20)。记录术后2、4小时及24小时心包纵隔引流量,并于CPB前、CPB30min、CPB结束时及CPB后1小时用ELISA法测定血清IL-6、IL-8和TNF-α浓度水平。结果抑肽酶组及糖皮质激素组术后心包纵隔引流量均少于对照组,但高于两者联合应用组;抑肽酶组及糖皮质激素组CPB开始后血清IL-6、IL-8和TNF-α浓度水平均低于对照组,但仍高于两者联合应用组。结论联合应用抑肽酶和大剂量糖皮质激素,无论在抗炎及减少术后出血两方面,其效果均优于两者中任何一种单独应用。

Objective To elucidate the protective effect of combination of aprotinin and high dose glucocorticoid in cardiopul-monary bypass (CPB). Methods Eighty patients for the first time with continuous infusion of blood cardioplegia, were randomized into four goups during CPB; Group A (n = 20), in which neither aprotinin nor glucocorticoid was used. Group B (n = 20), with aprotinin used. Group C (n=20), with high dose glucocorticoid used, and group D (n = 20), with combination of aprotinin and high dose glucocorticoid. The volume of mediastinal and pericardiac drainage during the first 2, 4 and 24h was recorded, and the serum levers of IL-6, IL-8 and TNF-o were measured at four time points. Results The volume of mediastinal and pericardiac drainage in group B, C and D was much less compared to group A. Among group B, C and D, the volume of mediastinal and pericardiac drainage in group D was much less than that in group B and C. The serum levers of IL-6, IL-8 and TNF-a in group B, C and D were significantly downregulated compared to that in group A. Among group B, C and D, the serum levers of these cy-tokines in group D were the least. Conclusions Combination of aprotinin and high dose glucocorticoid in CPB may protect the patients from systemic inflammatory reaction syndrome and postoperation bleeding more effectively than single use of either aprotinin or glucocorticoid.