心脏瓣膜置换术中乌司他丁的应用对炎症相关因子与术后认知功能的影响

Effects of ulinastatin on inflammations reaction and postoperative cognition disorders in patients receiving cardiac valve replacement surgery

目的:观察乌司他丁对心脏瓣膜置换术患者全身炎症反应因子和术后认知功能的影响。方法:42例择期心脏瓣膜置换术患者,随机分为2组,乌司他丁组(U组)和对照组(C组),每组21例。U组于麻醉诱导后立即静脉泵入乌司他丁1.2万U/kg,CPB预充液加入乌司他丁0.6万U/kg,主动脉开放前5 min,体外循环机中加入乌司他丁0.6万U/kg;C组给予等容量生理盐水。于切皮前(T1)、体外循环结束后10 min(T2)、30 min(T3)、1 h(T4)、3 h(T5)和术后24 h(T6)时测定血浆白细胞介素(inter-leukin,IL)-6,IL-10、肿瘤坏死因子(tumor necrosis factor,TNF)-α和S100β蛋白,及用简易智能状态检测法(mini-mental stateexamination,MMSE)评估患者术前1 d和术后3 d认知状态,评定术后认知功能障碍(postoperative cognition disorders,POCD)。结果:与T1比较,两组在T2～T6时的IL-6、IL-10、TNF-α、S100β的浓度明显升高(P<0.05);与C组比较,U组在T2～T6时点的IL-6、TNF-α、S100β浓度显著降低(P<0.05),IL-10浓度显著升高(P<0.05);通过MMSE评定,对照组7例发生POCD(33.3%),U组2例发生POCD(9.5%),具有显著统计学差异(P<0.01)。结论:乌司他丁可降低心脏瓣膜置换手术患者POCD的发生率,其机制可能通过抑制体外循环的炎症反应,降低脑损伤,从而降低POCD的发生。

Objective： To investigate the effects of ulinastatin on inflammation reaction and postoperative cognition disorders（POCD） in patients undergoing cardiac valve replacement surgery.Methods： Total 42 patients undergoing cardiac valve replacement therapy with cardiopulmonary bypass（CPB） were randomly divided into two groups.Group U（n = 21）：the patients received ulinastitin 12 000 U/kg before incision by intravenously pumping,6 000 U/kg ulinastatin was added to the priming solution,and 6 000 U/kg ulinastatin was given before 5 min of the aortic decamping.Group C（n = 21）：the control group was used the same dose of saline.Blood plasma concentrations of IL-6,IL-10,TNF-α and S100β concentration were determined before incision（T1）,10 min after CBP（T2）,30 min after CBP（T3）,1 h after CBP（T4）,3 h after CBP（T5）,24 h after CBP（T6）.Cognition state of every patient was evaluated by minimental state examination（MMSE） at 1d before operation and 3d after operation to record the number of the incidence of POCD.Results： The plasma concentrations of IL-6,IL-10,TNF-α and S100β of two groups at each time point of T2 to T6 were significantly higher than those at T1 point,（P 0.05）;Compared to Group C,the plasma concentrations of IL-6,TNF-α,S100β in Group U were significantly lower and IL-10 in Group U was higher at each time point of T2 to T6（P 0.05）;The incidence of POCD in group C（7 patients） was significantly higher than that in group U（2 patients）（P 0.01）.Conclusion： Prophylactic of ulinastatin in patients undergoing the cardiac valve surgery can decrease the incidence of POCD.The possible mechanism was that ulinastatin could cut down the relationship between inflammatory reaction in CBP and POCD.