摘要
目的:探讨地塞米松对体外循环下心脏瓣膜置换术患者血S-100β和神经元特异性烯醇化酶(NSE)的影响及其机制。方法:择期体外循环下心脏瓣膜置换术病人30例,年龄31~63岁,体重46~76 kg,ASAⅡ或Ⅲ级,随机分为地塞米松组和对照组。地塞米松组于手术开始前1 h静注地塞米松0.5 mg/kg,对照组静注等量生理盐水。在静注地塞米松前(T_1)、体外循环开始(转机)即刻(T_2)、体外循环结束时(T_3)、手术结束时(T_4)、术后24 h(T_5)、术后48 h(T_6)采集静脉血(T_1取自外周静脉,T_2~T_6取自颈内静脉置管),采用ELISA法测定TNF-α、IL-1β及脑损伤标志物S-100β蛋白和NSE的浓度。结果:两组病人IL-1β、TNF-α浓度在T_2~T_5均高于T_1(P<0.05),且地塞米松组低于对照组(P<0.05),T_6恢复至T_1水平。两组病人NSE浓度在T_3~T_6时明显高于T_1~T_2(P<0.05),且T_3~T_5时地塞米松低于对照组(P<0.05)。两组病人S- 100β蛋白浓度在T_3~T_5时高于T_1~T_2(P<0.05),T_6时基本恢复至T_1水平,且在T_3~T_4时地塞米松低于对照组(P<0.05)。结论:地塞米松能降低心脏瓣膜置换术病人血S-100β和NSE的水平,其脑保护机制与减少促炎细胞因子释放有关。
AIM: To observe the effects of dexamethasone (DXM) on blood S-100β and Neuron Specific Enolase(NSE) levels of cardiac valve replacement patients undergoing cardiopulmonary bypass ( CPB ). METHODS: 30 patients, who were 31 - 63 years old, weighted 46 - 76 kg, ASA Ⅱ - Ⅲ, were randomized to received 0.5 mg/kg dexamethasone ( dexamethasone group) or placebo( control group) 60 minutes before operation. The plasma levels of TNF-α, IL-1β, S-100β and NSE were measured at the following times: before the dexamethasone or placebo were administered( T1 ), before starting CPB( T2 ), the end of CPB( T3 ), immediately after operation(T4), 24 h after skin closure(T5 ) and 48 h after skin closure( T6 ). RESULTS: Both the plasma concentrations of TNF-α, IL-1β were upregulated after T2. S-100β and NSE were upregulated after T3 ( P 〈 0.05) and almostly resume to normal level at T6. The plasma concentrationS of TNF-α, IL-1β, S-100β and NSE in dexamethasone group were lower than those in placebo group (P 〈 0.05 ). CONCLUSION: Dexamethasone may decrease the blood S-100β and NSE levels after cardiopulmonary bypass by inhibitting the release of proinflammatory cytokine.
出处
《中国临床药理学与治疗学》
CAS
CSCD
2007年第12期1424-1427,共4页
Chinese Journal of Clinical Pharmacology and Therapeutics
基金
山东省科技攻关计划赞助(2006GG3202004)
关键词
地塞米松
体外循环
全身炎症反应综合征
脑保护
炎性因子
dexamethasone
cardiopulmonary bypass
systemic inflammatory response syndroms
inflammatory cytokine
cerebral protection