围术期应用乌司他丁对老年患者脏器功能的保护作用及机制

Protection effect of the use of ulinastatin on elderly patients' organs

目的研究围手术期应用乌司他丁(UTI)对老年患者器官功能保护方面的作用及保护机制。方法选择择期上腹部手术老年患者80例,随机分为2组,各40例。U组患者于术前1 d开始用UTI 2.0万U·kg^(-1)加入50 mL生理盐水中用微泵注射,qd,使用至术后第5天止,手术日开放中心静脉后立即用微量泵快速泵入UTI;C组均以50mL生理盐水代替UTI使用,其他常规治疗同U组。并选择不同时间点检测患者的血清TNF-α、IL-6及HO-1;分别检测两组术前1 d及术后1、3、5 d血清TNF-α、IL-6、IL-8,即时记录两组患者术后体温变化情况。结果应用2.0万U·kg^(-1) UTI后U组在不同时间点IL-6、TNF-α的各项检验值均显著低于C组(P<0.05);且术后12、24 h的HO-1活性显著升高,两组间对比差异有统计学意义(P<0.05)。结论 UTI具有抑制促炎因子释放作用,同时可降低患者体内促炎因子TNF-α、IL-6、IL-8的水平,促进HO-1反应性上调,发挥抗缺血-再灌注损伤能力,从而起到脏器保护作用。

AIM To study the protective effect of the use of ulinastatin （UTI） on elderly patients＇ organs. METHODS A total of 80 elderly patients who had abdominal surgery were randomly divided into 2 groups, with 40 pa- tients in each group. Group U patients were injected with UTI of 20 000 U＂ kg- 1 by adding 50 mL normal saline with mi- cro-injection pump the day before surgery, and once a day, for only 5 d after surgery. On surgery day, after opening cen- tral venom, LIT[ was immediately injected with micro pump. In {Voup C, 50 mL normal saline were used instead of UTI, and other conventional treatment was the same as group U. Serum TNF-a, 1I,-6 and HO-1 were respectively detected at different time points. The serum TNF-a, IL-6 and IL-8 were tested the day before the surgery, 1, 3 and 5 d after the surgery, respectively in 2 groups. The temperature changes in patients＇ body were timely recorded after the surgery. RE- SULTS After the use of 20 000 U＂ kg-1 UTI, the test values of IL-6 and TNF-a in group U were significantly lower than those in group C（ P 〈0.05） at different periods. And the activity of HO-1 was significantly increased 24 h later, com- pared with 12 h later. The contrasts between the 2 groups were significant （ P 〈0.05）. It showed that UTI could inhibit the release of TNF-a and IL-6, and the activity of HO-1 was significantly increased 12 h later and 24 h later. CONCLU- SION UTI plays an important role in inhibiting the release of pro-inflammatory cytokines, and it can reduce the level of TNF-a, IL-6 and IL-8 in patients＇ body, promote the reaction of HO-1. By exerting the function of anti-ischemia-reper-fusion injury, it can protect the organs.