患儿法洛四联症矫治术中乌司他丁对脑损伤S100β蛋白和神经元特异性烯醇化酶的影响

Effect of ulinastatin on the expression of brain injury markers S100β protein and neuron-specific enolase in infants undergoing corrective surgery for tetralogy of Fallot

目的观察乌司他丁对患儿法洛四联症(tetralogy of Fallot,TOF)矫治术中血浆中S100β蛋白和神经元特异性烯醇化酶(NSE)浓度的影响。方法选择择期行心肺转流(cardiopulmonary bypass,CPB)下一期矫治术的TOF患儿40例,男25例,女15例,3～12月龄,采用密封随机分组信封法分为两组:乌司他丁组(U组)和对照组(C组),每组20例。两组麻醉诱导、维持及围术期用药相同,U组麻醉诱导后静脉给予乌司他丁10 000U/kg,CPB预充液中加入20 000U/kg;术后第1天开始应用乌司他丁30 000U·kg^(-1)·d^(-1),直至出ICU时停药。记录患儿CPB时间,并于诱导时(T1)、停CPB(T2)、术后24h(T3)、术后48h(T4)抽取静脉血3ml,采用ELISA法测定血浆中S100β蛋白和NSE浓度。结果 T1时两组S100β蛋白及NSE浓度均在正常范围内。与T1时比较,T2时两组S100β蛋白和NSE浓度明显升高(P<0.05),且达到峰值;T3—T4时两组S100β蛋白浓度明显下降(P<0.05);T3时两组NSE浓度降低,T4时基本恢复至T1时水平。结论在TOF患儿CPB术中,乌司他丁可降低血浆中脑损伤标志物S100β蛋白和NSE浓度,从而产生一定的脑保护作用。

Objective To observe the effect of ulinastatin on the expression of S100βprotein and neuron-specific enolase（NSE）in infants undergoing corrective surgery for tetralogy of Fallot（TOF）.Methods Forty cases of TOF,25 males and 15 females,undergoing elective corrective operations for cardiopulmonary bypass were randomly divided into two groups（n=20 each）：ulinastatin group（group U）and control group（group C）.Routine general anesthesia procedures were administered to both groups while the group U was treated with ulinastatin.Ulinastatin 10 000 U/kg was given from the right internal jugular vein after anesthesia induction,and ulinastatin 20 000 U/kg was given to the extracorporeal circulation priming liquid.On the first day after the operation,ulinastatin was continued for 30 000 U·kg^-1·d^-1,until the infant met the conditions of the withdrawal from ICU.Venous blood samples 3 ml were extracted after induction（T1）,30 min after CPB（T2）,24 hafter the end of the operation（T3）and 48 hafter the end of the operation（T4）.The blood plasma was centrifugated so that S100βprotein and NSE concentration was determinated with ELISA.Results Serum S100βprotein and NSE concentration of the two groups of patients at T1 was in normal level and increased rapidly after the CPB,and group C increased significantly with a statistical difference between the two groups（P〈0.05）.The concentration of both groups reached the peak value at T2,and the difference was statistically significant（P〈0.05）compared with T1,then the concentration decreased slowly.The level of S100βprotein was statistically different between T3,T4 and T1（P〈0.05）while the level of NSE was statistically different between T3 and T1（P〈0.05）.The concentration of NSE returned to the preoperative level at T4.Conclusion During the corrective operation for TOF in infant,increasing plasma S100βprotein and NSE concentration can be inhibited by ulinastatin which may result in a certain degree of brain protection effect.