乌司他丁对小儿肝母细胞瘤切除术围手术期炎症因子及血糖水平的影响

Effects of ulinastatin on inflammatory factors and blood glucose level during resection of pediatric hepatoblastoma

目的观察乌司他丁对小儿肝母细胞瘤切除术围手术期炎症因子及血糖水平的影响。方法选择2021年3月至2022年8月在首都医科大学附属北京儿童医院保定医院接受肝母细胞瘤切除术的50例患儿,患儿性别不限,年龄1~3岁,患儿肿瘤PRETEXT分期为Ⅰ或Ⅱ期,心功能分级Ⅰ~Ⅱ级,美国麻醉医师协会分级Ⅱ级。将50例患儿按数字随机法平均分成两组:生理盐水对照组(C组,25例)、乌司他丁组(U组,25例)。U组患儿在麻醉诱导后及分离肿瘤时使用乌司他丁,而C组患儿同期使用同容量生理盐水,两组患儿其余手术操作均无差别。比较两组患儿一般资料及麻醉诱导后(T0)、切除肿瘤时(T_(1))、术毕(T_(2))、术后2 h(T_(4))两组患儿外周血肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素(interleukin,IL)-6、IL-10浓度、血糖水平及C反应蛋白(C-reactive protein,CRP)浓度。组间比较采用t检验,组内各时间点比较采用重复测量方差分析。结果两组患儿年龄、体重、脑电双频指数、手术时间、肝门阻断时间及各时间点平均动脉压、心率比较,差异均无统计学意义(均P>0.05),具备可比性。两组患儿T_(1)、T_(2)、T_(4)时的TNF-α、IL-6、IL-10浓度均明显高于T0(均P<0.05)。T_(1)、T_(2)、T_(4)时U组的TNF-α、IL-6浓度明显低于同期C组(均P<0.001),T_(1)、T_(2)、T_(4)时U组的IL-10浓度明显高于同期C组(均P<0.001)。两组患儿T_(1)、T_(2)、T_(4)时的CRP浓度均明显高于T0(均P<0.05)。T_(1)、T_(2)、T_(4)时U组的CRP浓度明显低于同期C组(均P<0.05)。两组患儿T_(1)、T_(2)时血糖水平明显高于T0时(P<0.05);至T_(4)时血糖水平有所下降,而U组血糖水平较C组更低(P=0.007)。结论乌司他丁可以降低小儿肝母细胞瘤切除术围手术期炎症因子TNF-α、IL-6及CRP浓度,增加IL-10浓度,稳定血糖水平。

Objective To observe the effect of ulinastatin on inflammatory factors and blood glucose(BG)level during resection of pediatric hepatoblastoma.Methods From March 2021 to August 2022,50 children underwent resection of hepatoblastoma at Baoding Hospital of Beijing Children's Hospital.The inclusion criteria were no gender limit,age 1 to 3 years,tumor PRETEXT stage I/Ⅱ,cardiac function grade I~Ⅱand American Association of Anesthesiologists gradeⅡ.They were randomized equally into two groups of saline control(C,n=25)and ulinastine(U,n=25).Group U used ulinastatin after anesthetic induction and during tumor isolation while Group C the same volume of saline at the same time.There was no difference in other surgical procedures between two groups.General profiles of two groups[tumor necrosis factor-alpha(TNF-α),interleukin-10(IL-10),BG,C-reactive protein(CRP)&interleukin-6(IL-6)]were compared after anesthesia(T_(2))and 2h(T_(4)).Inter-group comparisons were performed by t-test and repeated measures analysis of variance for comparisons of each timepoint within groups.ResultsIn both groups,age,body weight,electroencephalographic double-frequency index,operative duration,hilar block time,mean arterial pressure and heart rate at each timepoint were comparable and not statistically significant(all P>0.05).TNF-α,IL-6 and IL-10 at T_(1)/T_(2)/T_(4)were significantly higher than T 0(all P<0.05).And TNF-αand IL-6 in group U at T_(1)/T_(2)/T_(4)were significantly lower than those in group C(all P<0.001)while IL-10 in group U at T_(1),T_(2)and T_(4)was significantly higher than that in group C(all P<0.001).In both groups,CRP at T_(1),T_(2)and T_(4)was significantly higher than that at T 0(all P<0.05).CRP in group U at T_(1),T_(2)and T_(4)was significantly lower than that in group C(all P<0.05).In both groups,BG at T_(1)and T_(2)were significantly higher than that at T 0(all P<0.05);BG decreased by T_(4),while group U was lower than that in group C(P=0.007).Conclusions Ulinastatin may lower the levels of perioperative inflammatory cytokine TNF-α,IL-6 and CRP,increase IL-10 concentration and stabilize BG level.