乌司他丁对老年患者上腹部手术后血红素氧合酶-1与细胞因子的影响

Effects of Ulinastatin on Heme Oxygenase-1 and Cytokines in Old Patients Undergone Epigast Operation

目的探讨乌司他丁（UTI）对老年患者上腹部手术后血红素氧合酶-1（HO-1）活性和细胞因子变化的影响。方法择期行上腹部手术老年患者40例，随机分为两组（n=20）。试验组给予鸟司他丁1万U·kg^-1；对照组给予等容积0．9％氯化钠注射液。乌司他丁给药方法：患者入室开放中心静脉，随即开始采用微量泵快速泵入乌司他丁，于切皮前泵入总量1／3（约30min），余2／3维持至手术结束。分别于中心静脉开放后即刻（t0）、术毕（t1）、术后6h（t2）、术后12h（t3）、术后24h（t4）时点取中心静脉血检测血清肿瘤坏死因子（TNF·α）、白细胞介素-6（IL-6）及HO-1，并行统计学分析。结果与t0点比较，对照组HO-1活性t3时开始升高，t4时达峰值（P〈0．05），IL-6浓度术后各时点均升高，t2时达高峰（P〈0．05），TNF-α浓度术后各时点均升高，t3时达峰值呈进行性升高（P〈0．05）；与对照组比较，试验组HO-1活性t4时升高（P〈0．05），1L-6浓度t1～t4时均降低（P〈0．05），TNF-α浓度t2～t4时降低（P〈0．05）。结论老年患者上腹部手术后TNF-α、IL-6浓度及HO-1活性明显升高，乌司他丁能明显减少老年人上腹部手术后血清细胞因子TNF-α、IL-6的释放，促进血清HO-1活性升高。

Objective To investigate the effects of ulinastatin （UTI） on heme oxygenase-1 （ HO-1 ） and cytokines in old patients undergone epigast operation. Methods Forty old patients undergoing epigast operation were randomly divided into 2 groups （n =20）. The tested group（U） was given UTI 10 000 U·kg^-1; and the control group （C）was treated with the same volume of normal saline. The central vein was opened for patients undergoing operation, the 1/3 total amount of UTI was quickly pumped into central vein via micro pump before skin incision, thereafter the other 2/3 amount of UTI maintained pumping until the operation completed. The blood from central veins in 2 groups was taken out for detecting tumor necrosis factor-alpha（ TNF-α） 、Interleukin-6 （IL-6） and HO-1 at time points： immediately after central vein open （to ）, immediately after operation （t1）、6 h after operation（ t2 ）, 12 h after operation （t3 ） ,24 h after operation（ t4 ）, respectively. Results Compared with that at to, the lower activity of HO-1 before operation began to rise at t3 and reached to the peak at t4 （P 〈0.05 ） ;IL-6 was increased at every time points after operation, and approached to the peak at t2 （ P 〈 0.05 ）. The same results were also showed for TNF-α, which was increased in progress to the peak at t3 （ P 〈 0.05 ）. In comparison with group C, HO-1 in group U at t4 was increased obviously （ P 〈 0.05 ） , IL-6 was decreased significantly at t1 - t4 （ P 〈 0.05 ） , and TNF-α was decreased at t2 - t4 （ P 〈 0.05 ）. Conclusion The level of TNF-α,IL-6 and HO-1 increase obviously in old patients undergone epigast operation. UTI inhibits the secretion of cytokines （TNF-α,IL-6） and activates HO-1.