米力农对风湿性心脏病瓣膜置换术后患者肝、肾功能及血清炎性因子的影响

Effects of milrinone on levels of inflammatory factors and liver and renal function after CPB in rheumatic heart disease patients for valve replacement

目的探讨乳酸米力农对风湿性心脏病体外循环瓣膜置换术后患者炎性因子及肝肾功能的影响和意义。方法收集2014年1月至2016年1月在重庆三峡中心医院因风湿性心脏瓣膜行瓣膜置换术的患者80例,采用区组随机分组方法将其分为观察组和对照组,各40例。观察组为体外循环术后以0.5 μg·kg-1·min-1持续静脉泵入米力农72 h的风湿性心脏病瓣膜置换术患者,对照组术后未使用米力农治疗患者。比较两组患者血清白细胞介素6(IL-6)、白细胞介素8(IL-8)、白细胞介素10(IL-10)、肿瘤坏死因子α(TNF-α)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血清肌酐(Scr)水平及手术时间、转流时间、阻断时间、机械通气时间、入住ICU时间、住院时间。结果两组TNF-α、IL-6、IL-8及IL-10术后即刻均升高[对照组:(14.97±5.14)pg/mL、(52.45±10.37)pg/mL、(34.10±8.38)pg/mL、(32.27±8.45)pg/mL,观察组:(16.05±5.71)pg/mL、(54.39±8.56)pg/mL、(33.80±7.69)pg/mL、(31.48±5.94)pg/mL,t=-0.628、-0.644、0.116、0.342],术后第1天达峰值[对照组:(52.07±10.18)pg/mL、(96.04±26.45)pg/mL、(91.14±18.28)pg/mL、(48.10±9.78)pg/mL,观察组:(50.37±12.98)pg/mL、(93.66±24.10)pg/mL、(83.16±16.28)pg/mL、(46.68±9.25)pg/mL,t=0.559、0.295、1.458及0.473],IL-10术后第3天达峰值(t=-3.577),均在术后第3天时差异有统计学意义[对照组:(36.03±9.39)pg/mL、(59.56±14.38)pg/mL、(53.91±13.16)pg/mL、(85.55±16.49)pg/mL,观察组:(36.70±4.33)pg/mL、(36.20±3.85)pg/mL、(42.91±7.30)pg/mL、(101.33±10.81)pg/mL,t=-0.289、7.017、3.267、-3.577];两组ALT、AST及Scr术后即刻均升高[对照组:(38.51±5.12)U/L、(40.23±5.03)U/L、(62.27±5.02)μmol/L,观察组:(39.20±4.67)U/L、(39.6±4.94)U/L、(73.61±4.04)μmol/L,t=0.114、0.243、0.630],两组比较术后第5天时差异有统计学意义[对照组:(61.45±5.27)U/L、(54.20±7.0)U/L、(86.45±9.01)μmol/L,观察组:(36.20±3.85)U/L、(34.85±7.12)U/L、(83.7±11.07)μmol/L,t=11.231、9.224、5.647],观察组第5天时均降至正常,而对照组仅Scr降至正常。两组手术时间、转流时间、阻断时间、机械通气时间差异均无统计学意义(t=0.267、0.151、0.187、0.773,均P>0.05),两组入住ICU时间和住院时间差异均有统计学意义[对照组:(54.90±16.84)h、(14.35±3.01)d,观察组:(44.05±7.06)h、(10±1.86)d,t=8.149、13.042,均P<0.05]。结论米力农可对风湿性心脏病体外循环瓣膜置换术后患者抑制全身炎性反应、保护肝、肾功能,减少术后并发症及住院时间。

Objective To investigate the effects of milrinone on levels of inflammatory factors and liver and renal function after CPB in rheumatic heart disease patients for valve replacement. Methods From January 2014 to January 2016, 80 patients received valve replacement in the Central Hospital of Chongqing Three Gorges were randomly divided into observation group and control group by block randomization grouping method, with 40 patients in each group.The patients in the observation group were pumped intravenously with milrinone 0.5μg·kg-1·min-1 for 72h after surgery, while the patients in the control group were not pumped.The serum levels of IL-6, IL-8, IL-10, TNF-α were detected by ELISA before operation and on 0d, 1d, 3d, 5d after operation, respectively.The levels of ALT, AST, Scr were also detected at the same time.Moreover, the time for operation, extracorporeal circulation, interruption, mechanical ventilation, ICU and hospital were also compared between the two groups. Results The levels of TNF-α, IL-6, IL-8 and IL-10 increased immediately after operation in both groups[control group:(14.97±5.14)pg/mL,(52.45±10.37)pg/mL,(34.10±8.38)pg/mL,(32.27±8.45)pg/mL;observation group:(16.05±5.71)pg/mL,(54.39±8.56)pg/mL,(33.80±7.69)pg/mL,(31.48±5.94)pg/mL, t=-0.628,-0.644, 0.116, 0.342], and the peak values of TNF-α, IL-6 and IL-8 reached on the first day after operation in both two groups[control group:(52.07±10.18)pg/mL,(96.04±26.45)pg/mL,(91.14±18.28)pg/mL,(48.10±9.78)pg/mL;observation group:(50.37±12.98)pg/mL,(93.66±24.10)pg/mL,(83.16±16.28)pg/mL,(46.68±9.25)pg/mL, t=0.559, 0.295, 1.458, 0.473], and the peak value of IL-10 reached on the 3rd day after operation(t=-3.577), the differences were statistically significant on the 3rd day after operation[control group:(36.03±9.39)pg/mL,(59.56±14.38)pg/mL,(53.91±13.16)pg/mL,(85.55±16.49)pg/mL;observation group:(36.70±4.33)pg/mL,(36.20±3.85)pg/mL,(42.91±7.30)pg/mL,(101.33±10.81)pg/mL, t=-0.289, 7.017, 3.267,-3.577]. The levels of ALT, AST and Scr increased immediately after operation in both groups[control group:(38.51±5.12)U/L,(40.23±5.03)U/L,(62.27±5.02)μmol/L;observation group:(39.20±4.67)U/L,(39.6±4.94)U/L,(73.61±4.04)μmol/L, t=0.114, 0.243, 0.630], there were tatistically significant difference between the two groups on the 5th day after operation[control group:(61.45±5.27)U/L,(54.20±7.0)U/L,(86.45±9.01)μmol/L;observation group:(36.20±3.85)U/L,(34.85±7.12)U/L,(83.7±11.07)μmol/L, t=11.231, 9.224, 5.647], and on the fifth day, the levels of ALT, AST and Scr in the observation group dropped to normal, while only the level of Scr in the control group dropped to normal.There were no statistically significant differences in the time of operation, extracorporeal circulation, interruption, mechanical ventilation between two groups (t=0.267, 0.151, 0.187, 0.773, all P>0.05). However, there were statistically significant differences in the time of ICU and hospital [control group:(54.90±16.84)h,(14.35±3.01)d, observation group:(44.05±7.06)h,(10±1.86)d, t=8.149, 13.042, all P<0.05]. Conclusion Milrinone can obviously improve the inflammatory reaction in surgical trauma tissues caused by IL-6, IL-8, IL-10, TNF-α, and can protect liver, renal tissue from injury, moreover, it can decrease the incidence of postoperative complications and the length of hospital stay.