乌司他丁对脑肿瘤切除患者炎症反应和术后脑水肿的影响

Effects of Ulinastatin on Inflammation Responses and Postoperative Brain Edema in Patients Undergoing Supratentorial Neoplasms Surgery

目的评价乌司他丁对脑肿瘤切除患者炎症反应和术后脑水肿的影响。方法选取2019年1—6月在首都医科大学宣武医院神经外科择期全身麻醉下行幕上肿瘤切除术的50例患者作为研究对象,采用随机数字表法分为对照组和乌司他丁组,各25例。两组患者的麻醉方法及监测方法相同。麻醉诱导后乌司他丁组静脉输注乌司他丁6000 U/kg(溶于20 mL 0.9%氯化钠注射液),对照组输注等容量0.9%氯化钠注射液,均于30 min内输注完毕。记录两组患者肿瘤性质、麻醉时间、手术时间、术中补液量、出血量、尿量、重症监护病房(ICU)停留时间和术后住院时间。评估术前瘤周水肿和术后第1天脑水肿程度。分别于麻醉诱导前10 min(T 0)、剪硬膜即刻(T 1)、术毕即刻(T 2)、术后24 h(T 3)和术后72 h(T 4)采集静脉血,检测血清肿瘤坏死因子-α(TNF-α)和白细胞介素-1β(IL-1β)水平。结果两组肿瘤性质、手术时间、麻醉时间、术中补液量、出血量、尿量、ICU停留时间以及术后住院时间比较差异无统计学意义(P>0.05)。TNF-α水平的组间和时点间存在交互作用(P<0.05),两组不时点间TNF-α的变化趋势不同,乌司他丁组各时点间TNF-α水平较为稳定。血清IL-1β水平的组间和时点间存在交互作用(P<0.05),两组不时点间IL-1β的变化趋势不同,与T 0比较,两组T 1~T 2时点血清IL-1β水平升高(P<0.05),两组T 3~T 4时点血清IL-1β水平降低(P<0.05);与对照组比较,乌司他丁组T 2~T 4时点血清IL-1β水平降低(P<0.05),其余时点间两组比较差异无统计学意义(P>0.05)。两组患者术前瘤周水肿评分和术后第1天脑水肿评分比较差异无统计学意义(P>0.05)。结论乌司他丁6000 U/kg可有效抑制脑肿瘤切除术患者的术后炎症反应,但未发现可减轻患者术后脑水肿程度。

Objective To investigate effects of ulinastatin on inflammation responses and postoperative brain edema in patients undergoing supratentorial neoplasms surgery.Methods Fifty patients undergoing elective supratentorial neoplasms surgery with general anesthesia in Xuanwu Hospital,Capital Medical University from Jan.to Jun.2019 were enrolled in this study and assigned into a control group and a ulinastatin group according to the random number table method,25 cases each.Both groups received the same anesthesia and monitoring regimens.The ulinastatin group received ulinastatin 6000 U/kg(dissolve in 20 mL of 0.9%sodium chloride injection)intravenously after induction of anesthesia and completed within 30 min,while the control group received the same amount of saline infusion at the same time.The types of tumor,anesthesia time,operation time,intraoperative fluid supply,blood loss and urine volume,the length of intensive care unit(ICU)stay and hospital stay after the surgery were recorded.Peritumoral edema before operation and brain edema 1 d after the surgery were assessed.Serum tumor necrosis factor-α(TNF-α)and interleukin-1β(IL-1β)levels were measured 10 min before anesthesia(T 0),immediately after cutting the dura(T 1),the end of surgery(T 2),24 h after the surgery(T 3)and 72 h after the surgery(T 4).Results There was no statistically significant difference between the two groups in the nature of the tumor,the time of operation,the time of anesthesia,the amount of fluid replacement during operation,the amount of bleeding,the amount of urine,the length of stay in ICU,and the length of hospital stay after surgery(P>0.05).There was an interaction in TNF-αlevels between groups and time points(P<0.05).The changing trend of TNF-αof the two groups from time to time was different,and the level of TNF-αwas more stable in the ulinastatin group at each time point.There was an interaction in the levels of serum IL-1βbetween groups and between time points(P<0.05).The changing trend of IL-1βof the two groups from time to timewas different.Compared with T 0,the level of serum IL-1βbetween T 1 and T 2 points in both groups increased(P<0.05),while serum IL-1βlevels decreased at T 3-T 4 points in both groups(P<0.05);compared with the control group,serum IL-1βlevels decreased at T 2-T 4 points in the ulinastatin group(P<0.05),the difference between the two groups at other time points was not statistically significant(P>0.05).There was no significant difference of peritumoral edema before operation and brain edema 1 d after the surgery between the two groups(P>0.05).Conclusion Ulinastatin 6000 U/kg can effectively inhibit inflammatory response of the patients after brain tumor dissection in the postoperative period.However,the improvement on brain edema alleviation has not been observed.