不同剂量抑肽酶对体外循环心脏手术炎性反应的作用

Effects or different-dose aprotinin on the inflammatory responses to cardiopulmonary bypass

目的观察不同剂量抑肽酶对体外循环（ＣＰＢ）心脏手术炎性反应的影响。方法２６例双瓣膜替换术病人，随机分为大剂量组：ＣＰＢ前静给抑肽酶２００万ＫＩＵ，预充液中加入２００万ＫＩＵ，术中静滴５０万ＫＩＵ／ｈ，至关胸结束（ｎ＝１３）；小剂量组：ＣＰＢ前静给抑肽酶１００万ＫＩＵ，预充液中加入 １００万 ＫＩＵ，术中静滴 ２５万 ＫＩＵ／ｈ，至关胸结束（ ｎ＝ １３）。分别于 ＣＰＢ前、ＣＰＢ结束、停机后 ２ｈ取挠动脉血测定中性粒细胞ＣＤ１１ｂ表达及血浆ＴＮＦ－α、ＩＬ－６水平。结果ＣＰＢ前两组ＣＤ１１ｂ表达、ＴＮＦ－α及ＩＬ－６水平无明显差异（Ｐ＞０．０５），ＣＰＢ结束及停机后２ｈ时大剂量组均低于小剂量组（Ｐ＜０．０５）。且与 ＣＰＢ前相比，大剂量组于 ＣＰＢ结束、停机后 ２ｈ时 ＣＤ１１ｂ表达、ＴＮＦ－α水平无明显变化（Ｐ＞０．０５）。结论大剂量抑肽酶抑制炎性反应的效应好干小剂量抑肽酶。

Objective To observe the effects of different-dose aprotinin on the inflammatory responses to cardiopulmonary bypass (CPB). Methods Twenty-six patients, undergoing heart valves replacement, were randomly assigned to receive intravenous infusion of aprotinin 2× 106 KIU before CPB followed by a continuous infusion of 5× 105 KIU/h during surgery untill chest closure additionally with 2× 106 KIU being added to the pump prime (high-dose group, n = 13 ) or intravenous infusion of aprotinin 1× 106 KIU before CPB followed by a continuous infusion of 2.5× 105 KIU/h during surgery untill chest closure additionally with 2× 106 KIU being added to the pump prime (low-dose group, n = 13), respectively. The arterial blood samples were taken before CPB, at the end of CPB, and 2h after weaning from CPB to measure the neutrophil CD11b integrin expression and plasma levels of tumor necrosis factor-a (TNF-a) and interleukin-6 (IL--6) .Results There were not significant differences in the neutrophil CD11b inteqrin expression, levels of TNF--a and IL-6 before CPB between both group (P >0. 05), which were markedly lower in high-dose group than in low-dose group at the end of CPB and 2h after weaning from CPB (P < 0.05 ). The neutrophil CD11b integrin expression and level of TNF-a remained stable during the whole procedures in high-dose group (P >0. 05 ). Conclusions The high-dose aprotinin is more effective to reduce the inflammatory response to CPB than low-dose aprotinin is.