摘要
目的:探讨重症心脏瓣膜病置换术的炎性因子改变和对器官功能的影响。方法:60例首次重症心脏瓣膜病置换术者随机分为乌司他汀组(A组),乌司他汀和抑肽酶组(B组),对照组(C组),各20例。于麻醉诱导前、体外循环(CPB)开始后30min、CPB结束30min及术后24h从中心静脉插管采集血标本,各时点分别测定,谷丙转氨酶(ALT)、谷草转氨酶(AST)、血尿素氮(BUN)、肌酐(CR)、心肌型肌酸激酶同工酶(CK-MB),并用放免法检测血浆肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6),白细胞介素-8(IL-8)和白细胞介素-10(IL-10)血浆水平。结果:乌司他汀组(A组)、乌司他汀和抑肽酶组(B组)、对照组(C组),3组术后ALT、AST、BUN、CR及CK-MB均有升高,但是对照组升高显著,A组和B组比较差异有显著性(P<0.05),A组、B组和对照组比较差异有显著性(P<0.01),TNF-α、IL-6和IL-8水平均比术前明显升高(P<0.05),开放升主动脉后1h达高峰,之后逐渐下降。对照组TNF-α、IL-6及IL-8明显高于诱导前以及相同时点治疗组的水平(P<0.01);CPB结束后30min及24h,3组IL-10水平均明显增高,但治疗组明显高于对照组(P<0.01)。结论:乌司他汀和抑肽酶联合应用能明显降低重症心脏瓣膜病置换术患者血浆TNF-α、IL-6和IL-8水平,同时可促进抑制炎细胞因子(IL-10)的分泌,从而有效降低由CPB引发的炎症反应,促进器官功能的恢复,其保护作用有待进一步研究。
Objective：Changes of inflammatory factors and their effects were studied in patients with severe valve disease. Method：Sixty patients with valve disease who receive valve replacement for the first time were divided into three groups： Ulinastatin group（group A）, Ulinastatin and Apretinin group （group B） and control group （group C）. Each group had 20 patients. Blood samples were taken from the central vein before anesthesia, 30 minutes after the beginning of the cardiopulmonary bypass（CPB）, 30 minutes after the end of the CPB and 24 hours after the operation, The serum levels of ALT, BUN, CR, AST, CK-MB and tumor necrosis factor（TNFA-α）, interleukin 6 （IL-6）, interleukin 8 （ IL-8 ）, interleukin 10 （ IL- 10） were detected respectively. Result： After the operation, serum levels of ALT, BUN, CR, AST, CK-MB increased in all three groups. But the serum levels of ALT, BUN, CR, AST, CK-MB were significant higher in group C than in other two groups （P 〈 0.01）. Serum levels of ALT, BUN, CR, AST, CK-MB in group A were significant different from those in group B. Serum levels of TNFA-α, IL-6, IL-8 increased after the beginning of the operation and reach peak value 1 hour after the opening of the aortic clamp. Serum levels of TNFA-α, IL-6, IL-8 in group C is significantly higher than group A and group B. IL-10 increased in all the three groups. The levels of IL-10 were significantly higher in groups A and group B than that in group C （P 〈 0.01）. Conclusion：Ulinastatin and Apretinin could decrease the serum levels of TNFA-α, IL-6, IL-8 in patients with severe valve disease who receive valve replacement. The secrete of inflammatory inhibitive factor IL-10 was also increased. The inflammatory response induced by CPB was decreased and recovery from the operation was promoted. Functions of protection should be further investigated.
出处
《心肺血管病杂志》
CAS
2008年第3期134-137,共4页
Journal of Cardiovascular and Pulmonary Diseases
基金
安徽省人才培养及科研带头人专项基金〔2005〕58号
关键词
体外循环
乌司他汀
炎性因子
肺保护
心脏外科手术
Cardiopulmonary bypass
Ulinastatin
Inflammatory factor
Lung protection
Cardiac surgical procedures
