乌司他丁对体外循环患儿炎症反应及氧自由基清除能力的影响观察

Effect of Ulinastatin on Inflammatory Response and Oxygen Free Radical Scavenging Ability in Children Undergoing Cardiopulmonary Bypass

目的:观察乌司他丁对体外循环(CPB)患儿炎症反应及氧自由基清除能力的影响。方法:选择2018年3月-2021年3月泰安市妇幼保健院收治的室间隔或房间隔缺损患儿120例作为研究对象,按照随机数字表法将患儿分为观察组及对照组,各60例。两组均根据患儿不同情况给予CPB房间隔修补术或室间隔修补术,观察组于开胸后主动脉插管前给予乌司他丁10000 U/kg静脉推注半量,另外半量混入CPB预充液中随转机进入体内;对照组将乌司他丁换为等量生理盐水给予同观察组相同操作。记录比较两组麻醉时间、手术时间、CPB时间、主动脉阻断时间及住院时间;分别于术前(T_(0))、CPB停止4 h(T_(1))及术后24 h(T_(2))采血测定炎症因子水平,包括血浆白细胞介素-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)及C反应蛋白(CRP)水平,氧自由基清除指标包括血浆超氧化物歧化酶(SOD)、丙二醛(MDA)水平,比较不同时间两组各因子水平差异。结果:两组麻醉时间、手术时间、CPB时间、主动脉阻断时间、住院时间比较,差异均无统计学意义(P>0.05)。两组T_(0)的IL-6、TNF-α、IL-8、IL-10、SOD、MDA比较,差异均无统计学意义(P>0.05);T_(1)、T_(2),对照组IL-6、TNF-α、IL-8、MDA及观察组IL-6、TNF-α、MDA均高于T_(0),观察组上述指标均低于对照组,两组IL-10均高于T_(0),且观察组均高于对照组(P<0.05);观察组T_(1)的IL-8高于T_(0),但低于对照组(P<0.05);对照组T_(1)、T_(2)及观察组T_(1)的SOD均低于T_(0),观察组T_(1)、T_(2)的SOD均高于对照组,差异均有统计学意义(P<0.05);T_(2),两组IL-6、TNF-α、IL-10、MDA及对照组IL-8均低于T_(1),对照组SOD高于T_(1),差异均有统计学意义(P<0.05)。结论:在患儿CPB心脏手术中,乌司他丁可有效抑制促炎因子升高,上调抗炎介质的释放,促进氧自由基清除,从而减少机体损伤。

Objective:To observe the effect of Ulinastatin on inflammatory response and oxygen free radical scavenging ability in children undergoing cardiopulmonary bypass(CPB).Method:A total of 120 children with ventricular septal or atrial septal defect treated in Tai’an Maternal and Child Health Care Hospital from March 2018 to March 2021 were selected as the research objects,according to the random number table method,the children were divided into observation group and control group,60 cases in each group.Both groups were given CPB atrial septal repair or ventricular septal repair according to different conditions of children,the observation group was given half of Ulinastatin 10000 U/kg intravenously before aortic intubation after thoracotomy,and the other half was mixed into CPB precharge and entered the body with the turn;in the control group,Ulinastatin was replaced with the same amount of Normal Saline and given the same operation as the observation group.Anesthesia time,operation time,CPB time,aortic occlusion time and hospital stay were recorded and compared between the two groups;the levels of inflammatory factors,including plasma interleukin-6(IL-6),interleukin-8(IL-8),interleukin-10(IL-10)and tumor necrosis factor-α(TNF-α),and oxygen radical scavenging index,including plasma superoxide dismutase(SOD)and malondialdehyde(MDA)were measured before operation(T_(0)),4 h after CPB(T_(1))and 24 h after operation(T_(2)),the above indexes were compared between the two groups at different times.Result:There were no significant differences in anesthesia time,operation time,CPB time,aortic occlusion time and hospital stay between the two groups(P>0.05).There were no significant differences in IL-6,TNF-α,IL-8,IL-10,SOD and MDA between the two groups at T_(0)(P>0.05);at T_(1) and T_(2),IL-6,TNF-α,IL-8,MDA in the control group,and IL-6,TNF-α,MDA in the observation group were higher than those at T_(0),the above indexes in the observation group were lower than those in the control group,IL-10 of the two groups were higher than those at T_(0),and the observation group were higher than those in the control group(P<0.05);IL-8 in the observation group at T_(1) was higher than that at T_(0),and that in the observation group was lower than that in the control group(P<0.05);the SOD of the control group at T_(1) and T_(2) and the observation group at T_(1) were lower than those at T_(0),and the SOD of the observation group at T_(1) and T_(2) were higher than those of the control group,the differences were statistically significant(P<0.05);at T_(2),IL-6,TNF-α,IL-10,MDA in the two groups and IL-8 in the control group were lower than those at T_(1),and SOD in the control group was higher than that at T_(1),the differences were statistically significant(P<0.05).Conclusion:Ulinastatin can effectively inhibit the increase of pro-inflammatory factors,up regulate the release of anti-inflammatory mediators,promote oxygen free radical scavenging and reduce body damage during CPB heart surgery in children.