乌司他丁对心肺转流下心脏手术患者炎症因子及认知功能的影响

Influence of Ulinastatin on Inflammatory Factors and Cognitive Function in Patients with Cardiac Surgery under Cardiopulmonary Bypass

目的：探索乌司他丁（UTI）对心肺转流（CPB）下心脏手术患者炎症因子及认知功能的影响。方法：选择自2010年5月至2014年9月我院收治的CPB瓣膜置换手术患者60例,按照随机数表法将患者分成对照组和观察组,每组30例。观察组患者在麻醉诱导后静脉泵入1.2×10-4U/kg UTI,在CPB结束前5 min从体外管道内给予0.6×10-4U/kg UTI,对照组患者给予等量的生理盐水。对比两组CPB前（T0）、CPB开始后1 h（T1）、CPB结束后1 h（T2）、术后4 h（T3）及术后24 h（T4）的血浆肿瘤坏死因子-α（TNF-α）、白细胞介素-6/10（IL-6/10）、中性粒细胞弹性蛋白酶（NE）、星形胶质细胞S100蛋白的β亚型（S100β）、超氧化物歧化酶（SOD）和丙二醛（MDA）,在术前1 d和术后7 d时,采用简易精神状态检查表（MMSE）对患者进行神经精神功能测试,并评价患者的术后认知功能障碍（POCD）的发生率。结果：与T0相比,两组患者T1-T4的TNF-α、IL-6、NE、S100β、MDA水平明显升高,且观察组显著低于对照组,而两组IL-10、SOD水平显著下降,观察组显著高于对照组（P〈0.05）。术后7d,两组患者MMSE评分均明显高于术前1 d,且观察组显著高于对照组（P〈0.05）;观察组POCD的发生率明显低于对照组（P〈0.05）。结论：UTI可以有效降低CPB下行瓣膜置换术患者的炎症因子水平,并改善患者的POCD,对于临床用药具有指导意义。

Objective： To explore the influence of ulinastatin（UTI） on the inflammatory factors and cognitive function in patients with cardiac surgery under cardiopulmonary bypass（CPB）. Methods： A total of 60 patients, who underwent CPB valvular replacement surgery in Nanchong Central Hospital of Sichuan Province from May 2010 to September 2014, were randomly divided into control group（n=30） and observation group（n=30）. The observation group was pumped into 1.2×10-4U/kg UTI through vein after anesthesia induction,and given 0.6 ×10-4U/kg UTI from vitro pipeline 5 min before the end of CPB, while the control group was given the same amount of saline solution. The serum tumor necrosis factor-α（TNF-α）,interleukin-6/10（IL-6/10）, neutrophil elastase（NE）, astrocytes S100 proteins βisoforms（S100β）, superoxide dismutase（SOD） and malondialdehyde（MDA） in the two groups before CPB（T0）, 1 h before CPB（T1）, 1h after CPB（T2）, 4 h after CPB（T3） and 24 h after CPB（T4） were compared respectively. The mini mental state examination（MMSE） The nervous mental functions of the patients 1 d before surgery and 7 d after surgery were tested by the mini mental state examination（MMSE）; and the incidence of postoperative cognitive function（POCD） was evaluated. Results： Compared with the T0, the levels of TNF-α, IL-6, NE, S100β and MDA in the two groups at T1-T4 significantly increased, and the above indexes of the observation group were significantly lower than those of the control group; meanwhile, the levels of IL-10 and SOD significantly decreased, but the above indexes of the observation group were significantly higher than those of control group（P〈0.05）. MMSE scores in the two groups 7 d after surgery were significantly higher than 1 d before surgery, in addition, the MMSE score of the observation group was significantly higher than that of the control group（P〈0.05）. The incidence of POCD in the observation group was obviously lower than that in the control group（P〈0.05）. Conclusions： UTI can effectively reduce the inflammatory factor levels of patients undergoing CPB valvular replacement surgery, and improve the POCD status, which gives a guiding significance to clinical medication.