沐舒坦对瓣膜置换患者血浆细胞因子和丙二醛、超氧化物歧化酶的影响

Effects of mucosuluvan on cytokines and oxygen free radicals during cardiopulmonary bypass in patients undergoing valve replacement

目的 探讨不同剂量沐舒坦对瓣膜置换患者血浆细胞因子和自由基水平的影响。方法 将 30例瓣膜置换术患者随机分为三组 :对照组 (C组 )、沐舒坦 1组 (M1组 ,6 0mg)和沐舒坦 2组(M 2组 ,12 0mg) ,每组各 10例。沐舒坦组分别于麻醉后切皮前加入半量沐舒坦 ,另半量则加入预充液中。分别于麻醉后切皮前 (T1)、心肺转流 (CPB) 30min(T2 )、开主动脉 30min(T3 )、停CPB 1h(T4)、术后 4h(T5)、2 4h(T6)测定血浆TNF α、IL 1β、IL 10和丙二醛 (MDA)浓度及超氧化物歧化酶(SOD)活性。结果 三组TNF α、IL 1β、IL 10、MDA和SOD在CPB后均升高 (P <0 0 5～ 0 0 1) ;M1组和M 2组TNF α于T2 ～T6时较C组低 (P <0 0 5～ 0 0 1) ;M1组IL 1β于T5时较C组低 ,M 2组则于T2 ～T5低于C组 ,于T3 ～T4低于M 1组 (P <0 0 5～ 0 0 1) ;M 1组IL 10仅于T2 时较C组升高 ,M2组则于T2 ～T5时较C组升高 (P <0 0 5 ) ;M2组MDA于T2 、T3 、T5时较C组和M 1组低 (P<0 0 5 ) ;C组SOD活性于T2 ～T5下降 ,M1组和M2组则无明显变化 ,M 2组于T2 ～T5时较C组高(P <0 0 5 )。结论 CPB心脏手术可促发炎性和抗炎细胞因子及自由基的释放 ;沐舒坦可抑制CPB心脏手术所致的全身性炎性反应 ,减少自由基的产生 ,从而减轻缺血 再灌注损伤 ,且有?

Objective To investigate the efficacy of mucosulvan on cytokines and oxygen free radicals in valve replacement surgery during cardiopulmonary bypass (CPB). Methods Thirty ASAⅡ-Ⅲ adult patients scheduled for cardiac valve replacement were randomly divided into control(group C),mucosulvan 1 (group M1,60 mg) and mucosulvan 2 (group M2,120 mg) group with 10 cases each. Half dose of mucosulvan was infused after skin incision and another half dose was added to the priming solution in group M1 or group M2,and same volume of normal saline as that in group M1 or M2 was given instead of mucosulvan in group C.Blood samples were taken before skin incision (T 1) ,at 30 min after start of CPB (T 2) ,30 min after aortic declamping (T 3) ,1 h after termination of CPB (T 4), 4 h (T 5) ,24 h (T 6) after operation for determination of plasma TNF-α,IL-1β,IL-10,MDA concentration and SOD activity. Results TNF-α level was lower at T 2-T 6 in group M1 and M2 than that in group C(P<0.05-0.01). IL-1β level was lower at T 5 in group M1 than that in group C,whereas the level at T 2-T 5 in group M2 was lower than that in group C and the level in group M2 at T 3-T 4 was lower than that in group M1(P<0.05-0.01). IL-10 level was higher at T 2 in group M1 than that in group C,whereas in group M2 at T 2-T 5 was higher than that in group C(P<0.05). MDA level at T 2-T 3?T 5 was lower in group M2 than that in group C and M1 (P<0.05).Compared with T 1 ,SOD activity decreased during CPB in group C ,the SOD activity was higher at T 2-T 5 in group M2 than that in group C(P<0.05). Conclusion CPB leads to a proinflammatory and antiinflamatory response,as well as oxygen free radicals release. Mucosulvan is effective in reducing CPB-induced inflammatory response and ischemic resperfusion injury in a dose-dependent manner.