盐酸戊乙奎醚对体外循环瓣膜置换术患者炎性反应的影响

Effects of Penehyclidine on Cytokins during Valve Replacement Surgery with CPB

目的：观察盐酸戊乙奎醚对体外循环（CPB）瓣膜置换术患者血浆炎性因子的影响。 方法：选择择期体外循环下瓣膜置换术患者20例，随机分为盐酸戊乙奎醚组（P组）和对照组（C组），每组10例，分别与麻醉诱导前（T0）,CPB 30min（T1）,主动脉开放10分钟（T2），CPB3h（T3）,24h（T4）抽取动脉血，测定血浆肿瘤坏死因子α（TNF-α）,血细胞介素-6（IL-6）,T IL-10浓度。 结果：C组TNF-α浓度于T1-T3各时点高于T0（P＜0.01）,而P组T1，T2时点TNF-α浓度较T0显著降低，其余时点与术前比较无明显变化，C组IL-6于T4时点高于P组（P＜0.05）,IL-10浓度明显低于P组，C组TNF-α浓度于T1-T4各时点均高于P组（P＜0.05）. 结论：盐酸戊乙奎醚可部分抑制CPB导致的炎性反应，可能与其改善微循环，膜稳定作用有关，并且由于其消除半衰期长，作用持久，对CPB术后SIRS及肺部并发症有一定的预防作用。

Objective： Inflammation plays a pivotal role in the pathogenesis of organ dysfunction after cardiopulmonary bypass （CPB）. The aim of this study was to investigate whether penehyclidine has effects on the inflammatory process and leukocytes in cardiac surgery patients undergoing CPB. Methods： A double-blind, prospective, randomized, placebo-controlled study was undertaken to assess the effect of penehyclidine on tumor necrosis factoralpha （TNF-alpha）, interleukin-6 （IL-6） and interleukin-10（IL-10） levels in 20 patients undergoing CPB for elective valve replacement surgery. In 10 patients, 3 mg of penehyclidine was added to 30 min before CPB; another 10 patients received saline solution as placebo. Results： In the control group, IL-6 level and TNF-α were significantly higher than the study group. IL-10 level after surgery in control group was significantly lower than study group. The progressive increment in TNF-alpha level observed was also significantly prominent in the control group. Conclusion： CPB-related whole body inflammatory response could be partially inhibited by intraoperative penehyclidine administration. This effect of penehyclidine would be helpful in preventing the well-known complications of CPB-induced systemic inflammation.