还原型谷胱甘肽对体外循环心脏瓣膜置换术患者炎性反应的影响

Effects of glutathione on inflammatory response in patients undergoing cardiac valve replacement with cardiopulmonary bypass

目的评价还原型谷胱甘肽（GSH）对体外循环（CPB）心脏瓣膜置换术患者炎性反应的影响。方法择期CPB下行心脏瓣膜置换术患者60例，随机数字表法分为对照组和GSH组（均n=30）。两组麻醉诱导及维持方法相同，GSH组于麻醉诱导后静脉注射GSH 100mg·kg^-1，对照组加入等量的氯化钠注射液。于麻醉诱导后（T1）、CPB即刻（T2）、CPB结束（T3）、CPB结束2h（T4）和6h（T5）采取中心静脉血样，测定血浆心肌肌钙蛋白I（cTn I），肿瘤坏死因子α（TNF-α）、白细胞介素（IL）-6、IL-1β和S100β蛋白的浓度。结果与T1时比较，T2～T5时两组血cTnI、TNF-α、IL-6、IL-1β和S100β蛋白的浓度均显著升高（P〈0．05）；GSH组T2～T5时血cTnI、TNF-α、IL-6、IL-1β和S100β蛋白的浓度均显著低于对照组（P〈0．05）。结论CPB下心脏瓣膜置换术中GSH100mg·kg^-1可抑制炎性反应，从而减轻心、脑损伤。

AIM To investigate the effects of glutathione （GSH） on inflammatory response in patients undergoing cardiac valve replacement with cardiopulmonary bypass. METHODS Sixty ASA physical status Ⅱ or m patients undergoing cardiac valve replacement with cardiopulmonary bypass （CPB）, were randomly divided into two groups （n = 30 each） ： control group and GSH group. Anesthesia induction and maintenance was same. A loading dose of glutathione 100 mg·kg^-1 was infused after anesthesia induction, while the equal volume of sodium chloride injection was infused in the control group. After induction （T1）, before CPB （T2）, after termination of CPB （T3）, at 2 h after the end of CPB （T4） and at 6h after the end of CPB （T5） , blood samples were obstained from the jugular vein for determination of serum concentrations of cardiac troponin I （cTnI）, tumor necrosis factor-alpha （TNF-α）, interleukin （IL） -6, IL-1β and S100β protein. RESULTS Compared with T1, serum cTnI, TNF-α, IL-6, IL-1β and S100β coneentrations were significantly increased at T2-T5. Compared with the eontrol group, serum cTnI, TNF-α, IL-6, IL-1β and S100β coneentrations were significantly deereased at T2-T5 in the glutathione group. CONCLUSION Glutathione can inhibit inflammtory response, thus reducing cardiae and cerebral injury in patients undergoing cardiac valve replacement with CPB.