乌司他丁对体外循环下胸腔镜辅助心脏手术患者炎症反应及认知功能的影响

Effects of ulinastatin on inflammatory reaction and postoperative cognitive dysfunction in patients undergoing video-assisted thoracoscopic surgery under cardiopulmonary bypass

目的观察乌司他丁对心肺转流(CPB)下行胸腔镜辅助心脏手术患者炎症反应及术后认知功能障碍(POCD)的影响。方法 40例择期CPB下行胸腔镜辅助心脏手术患者随机均分为乌司他丁组(U组)和对照组(C组)。U组于麻醉诱导后静脉泵入乌司他丁6000万U/kg,CPB预充液加入乌司他丁6000万U/kg,主动脉开放前5min,人工心肺机中加入乌司他丁6000万U/kg;C组给予等容量生理盐水。分别于切皮前(T0)、CPB开始后30min(T1)、CPB结束后30min(T2)、2h(T3)和24h(T4)时测定血浆IL-6、中性粒细胞弹性蛋白酶(NE)、TNF-α、IL-10和S100β蛋白;采用简易智能状态检测法评估患者术前1d和术后3d的认知功能状态。结果与T0比较,两组在T1-T4时的IL-6、NE、TNF-α和S100β的浓度升高(P<0.05);与C组比较,U组在T1-T4时的IL-6、NE、TNF-α和S100β浓度降低(P<0.05),IL-10浓度增加(P<0.05)。U组POCD的发生率低于C组(10%vs.40%)(P<0.01)。结论预防性应用乌司他丁可抑制CPB下行胸腔镜手术患者的炎症反应,降低POCD的发生率。

Objective To investigate the effects of ulinastatin on inflammatory reaction and postoperative cognitive dysfunction（POCD）in the patients undergoing video-assisted thoracoscopic surgery（VATS）under cardiopulmonary bypass（CPB）.Methods Forty patients undergoing cardiac VATS under CPB were equally and randomly divided into two groups.The patients of group U received ulinastitin 6000U/kg after anesthesia induction,ulinastatin 6000U/kg added to the priming solution,and ulinastatin 6000U/kg at 5min before aortic decamping.The patients of group C received same volume of normal saline instead of ulinastitin.Blood samples were obtained before skin incision（T0）,at 30 min after the start of CBP（T1）,30 min,2hand 24 hafter the termination of CBP（T2,T3,T4）to detect plasma concentrations of IL-6,neutrophil elastase（NE）,TNF-α,IL-10 and S100β.Mini-mental state examination was used to evaluate the cognition state of each patient one day before and 3days after surgery.Results Compared to those at T0,plasma concentrations of IL-6,NE,TNF-α,IL-10 and S100βat T1-T4 were significantly higher in two groups（P〈0.05）.Compared to group C,plasma concentrations of IL-6,NE,TNF-αand S100βat T1-T4 were significantly lower,while those of IL-10 was significantly higher in group U（P〈0.05）.The incidence of POCD in group U was significantly lower than that in group U（10% vs.40%）（P〈0.01）.Conclusion Prophylactic use of ulinastatin in the patients undergoing cardiac VATS under CPB can inhibit inflammatory reaction and decrease the incidence of POCD.