围麻醉期乌司他丁对体外循环下行心脏手术患者全身及脑部炎性反应的影响及其脑保护作用

EFFECTS OF ULINASTATIN ON SYSTEMIC AND CEREBRAL INFLAMMATORY RESPONSE IN PERIANESTHESIA PATIENTS WITH CARDIOPULMONARY BYPASS HEART SURGERY AND ITS PROTECTION ON BRAIN

目的探讨乌司他丁对体外循环下行心脏手术患者全身及脑部炎性反应的影响。方法将择期行心脏瓣膜置换术的28例患者随机分为观察组和对照组各14例,观察组于麻醉后及转机时静脉泵入乌司他丁,对照组静脉持续泵入等量生理盐水;比较麻醉后手术前(T0期)、体外循环30min(T1期)、主动脉开放1h(T2期)、4h(T3期)、24h(T4期)二组患者动脉和颈静脉球血肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平和颈静脉球血S-100β蛋白、神经元特异性烯醇化酶(neuron-specific enolase,NSE)水平。结果与T0期相比,二组患者T1期、T2期、T3期、T4期动脉、颈静脉球血TNF-α选<L-6期显著升高(P<0.05),至T3期到达高峰,T4期开始降低;其中对照组T1期、T2期、T3期TNF-α选<L-6水平显著高于观察组(P<0.05)。从T1期开始二组患者颈静脉球血S-100β蛋白、NSE水平显著升高,至T2期到达高峰,T3期开始降低,T4期降至最低,与T0期相比差异有统计学意义(P<0.05),其中观察组T1期、T2期、T3期、T4期颈静脉球血S-100β蛋白、NSE水平显著低于对照组(P<0.05)。结论围麻醉期给予乌司他丁能够减轻体外循环下心脏手术患者全身及脑部炎性反应,降低颈静脉球血S-100β蛋白、NSE水平,具有一定的脑保护作用。

Objective To explore the effects of Ulinastatin in systemic and cerebral inflammatory response in cardiopulmonary bypass heart surgery patients. Methods Twenty eight cases underwent heart valve replacement surgery patients treated in author＇s hospital were randomly divided into observation group and control group, 14 cases in each group, the observation group after anesthesia and turn the intravenous infusion of ulinastatin, while the control group intravenous infusion of saline. Tumor necrosis factor alpha （TNF-α）, interleukin （IL- 6） - 6 level and jugular bulb blood S- 100 13 protein, neuron specific enolase （neuron-specific enolase, NSE） levels of two groups of patients in arterial and jugular bulb blood were compared in anesthesia before operation （T0）, 30min （T1） during cardlopulmonary bypass, aortic opening lh（T2 ）, 4h （T3）, 24h （T4） period. Results Compared with To period, two groups of patients with T1, T2 stage, T3 stage, T4of the artery, jugular bulb blood TNF- α,IL-6 were significantly higher （P〈 0.05）, to reach the peak of T3, T4 stage started to decrease; among the control group stage T1 ,T2 stage, T3 of TNF-α, IL- 6 levels were significantly higher than those in the observation group （P〈0. 05）. From the beginning of the two groups of patients with T1 jugular bulb blood S- 100βprotein, NSE levels were significantly increased, to reach the peak period T2 , T3 period begins to decrease, T4 period to a mini- mum, compared with To of a statistically significant difference （P〈0.05）, in which the observation group stage T1 , T2 stage, T3 stage, T4 of the jugular bulb blood protein S- 100β, NSE levels were significantly lower than the control group （P〈0.05）. Conclusion Perianesthesia given ulinastatin can reduce cardiac surgery under cardiopulmonary bypass in patients with systemic and the brain inflammatory response, reduce the jugular bulb blood protein S-100β, NSE levels, has a protective role in the brain.