乌司他丁对深低温停循环手术围术期炎性因子的影响

Perioperative effects of ulinastatin on inflammatory factors under deep hypothermic circulatory arrest

目的探讨乌司他丁在深低温停循环手术围术期对患者全身炎性因子的影响。方法选取同期接受深低温停循环大血管手术的患者24例,随机分为两组,乌司他丁组(U组)和对照组(C组),每组12例。U组:预充液中加入乌司他丁2万U/kg。C组:预充液中除不加入乌司他丁外其他成分与U组相同。经腋动脉和/或股动脉、右房二级静脉插管建立体外循环。全部病例分别在体外循环开始前(T1)、主动脉阻断时(T2)、心脏复跳时(T3)和停机器后10 min(T4)4个时间点,抽取静脉血,观察炎性细胞因子:肿瘤坏死因子(TNF-α)、白介素(IL-6、IL-8)浓度的变化。结果与体外循环开始前比较,U组TNF-α和IL-6在T3和T4点浓度升高,IL-8在T3点浓度升高。与T1比较,C组TNF-α在T3点浓度升高,IL-8在T3和T4点浓度升高。组间比较,U组TNF-α、IL-6和IL-8浓度在T2、T3、T4点均较C组低,C组TNF-α和IL-8在T2和T3点浓度较U组增高更显著(P<0.05)。结论乌司他丁可抑制TNF-α、IL-6、IL-8等炎性因子的产生和释放,从而降低深低温停循环手术围术期患者的全身炎性反应。

Objective To discuss perioperative effects of ulinastatin on deep hypothermic circulatory arrest （DHCA） patients＇ inflammatory factors. Methods Tweny-four patients who went through DHCA on the great arteries in the same period were selected and randomly divided into two groups： the ulinastatin group （group U） and the control group （group C）, 12 each. In group U, 20 kU/kg ulinastatin were added into the priming solution ; Other than ulinastatin, group C＇s priming solution had exactly the same contents. Extra-corporeal circulation was es- tablished through two-level vein catheterization via the axillary and/or femoral artery, and the right atrium. For all patients, venous blood samples were taken at four points in time-pre-operation （ T1 ）, upon aortic cross clamping （T2）, upon cardiopulmonary resuscitation （ T3 ）, and 10 mins after the machine was stopped （T4） ry factors-tumor necrosis factor-α （TNF-a） to observe any change in the levels of inflammato- and interleukin （IL-6, IL-8 ）. Results Within group U, comparing with at T1, levels of TNF-α and IL-6 were increased at T3 and T4 ; levels of IL-8 increased at T3. In addition, there were lower contents of TNF-α, IL-6 and IL-8 in Group U than Group C at T2, T3 and T4 during the inter-group comparison. The elevated level of TNF-α and IL-8 in Group C was statistically significant at T2 and T3 （P 〈 0. 05 ）. Conclusion Ulinastatin can inhibit the generation and release of inflammatory factors including TNF- α, IL-6 and IL-8, thereby reducing inflammatory response in perioperative DHCA.