摘要
目的探讨氟比洛芬酯对心脏瓣膜置换手术患者炎性细胞因子和心肌损伤的影响。方法选择风心病瓣膜置换术患者50例,随机分为5组。Ⅰ组(对照组)给予脂肪乳剂0.2ml/kg,Ⅱ组、Ⅲ组在麻醉后切皮前15min分别给予氟比洛芬酯1、2mg/kg,Ⅳ组、Ⅴ组分别在停转流前15min给与氟比洛芬酯1、2mg/kg。于麻醉前(T0)、主动脉开放10min(T1)、停心肺转流后30min(T2)、4h(T3)、24h(T4)、48h(T5)测定血浆肿瘤坏死因子(TNF)-α、白介素(IL)-6、IL-10的浓度,同时测定T0、T3、T4、T5时点的血浆肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK)-MB浓度。结果与T0相比,Ⅰ组、Ⅳ组T1、T2时点TNF-α、IL-6血浆浓度升高;其余各组T1时点升高(P<0.01)。Ⅱ组、Ⅲ组T1、T2时点TNF-α、IL-6血浆浓度比Ⅰ组低(P<0.01)。与T0相比,Ⅰ组T1～4时点IL-10血浆浓度升高,其余各组T1～3升高(P<0.01)。Ⅱ组、Ⅲ组T1～4时点IL-10血浆浓度比Ⅰ组低(P<0.01)。Ⅰ组T3～5cTnI、CK-MB血浆浓度升高,其余各组T3、T4时点升高(P<0.01)。Ⅱ组、Ⅲ组T3～5时点cTnI、CK-MB血浆浓度比Ⅰ组低(P<0.01);Ⅳ组T4、T5时点cTnI浓度比Ⅱ组低(P<0.05)。Ⅱ组、Ⅲ组多巴胺使用量比Ⅰ组少(P<0.01),Ⅴ组多巴胺使用量比Ⅲ组少(P<0.05);Ⅳ组ICU驻留时间比Ⅱ组短、Ⅴ组ICU驻留时间比Ⅲ组短。结论氟比洛芬酯具有抑制炎性细胞因子过度释放、维持细胞因子动态平衡,减轻围心肺转流期心肌损伤的作用,有助于患者术后早期康复。
Objective To investigate the effects of flurbiprofen axetil （FA）on inflammatory cytokines and myocardiac injury in patients undergoing cardiac valve replacement surgery with cardiopulmonary bypass （CPB）. Methods Group Ⅰ received 0.2 mL/kg intralipid 15min before skin incision,group Ⅱ , Ⅲ received flurbiprofen 1 mg/kg,2 mg/kg respectively 15 rain before skin incision,Group IV, Vreceived FA the same dosage as group Ⅱ, Ⅲ 15 min before the termination of CPB. Fifty patients scheduled for cardiac valve replacement surgery were randomly devided into five groups, each group has 10 patients. Blood samples were taken at pre-anesthesia（ T0 ） , 15 rain after aorta declarnped（ T1 ） ,30 min（ T2 ） ,4 h（ T3 ） ,24 h（ T4 ） ,48 h（ T5 ） after termination of CPB for plasma TNF-α, IL-6, IL-10 concentration. The plasma level of cTnI and CK-MB were detected at T0, T3, T4, T5. Results The plasma TNF-α,IL-6 levels were higher in group Ⅰ , Ⅳ at T1 ,T2 and in other groups at T1 than TO respectively; TNF-α,IL- 6 levels at T1 ,T2 was lower in group Ⅱ ,Ⅲ than group Ⅰ. The plasma IL-10 level was higher in group Ⅰ at T1-4 and in other groups at T1-3 than To respectively; IL-10 level at T1-4 was lower in group Ⅱ, Ⅲ than group Ⅰ. The plasma cTnI,CK-MB levels were higher in group Ⅰ during T3-5, and in other groups during T3 -4 than T0. Com- pared to group Ⅰ ,the plasma cTnI, CK-MB levels of group Ⅱ , group m was lower during T3-5; the plasma cTnI levels at T4,T5 in group IV was lower than group Ⅱ. The dopamine dosage of group lI ,llI was lower than group Ⅰ. The duration of ICU stay in group Ⅱ, Ⅲ was longer than group Ⅳ ,Ⅴ respectively. Conclusion Flurbiprofen can effectively inhibit pro-inflammatory cytokines, maintain the balance of cytokines and reduce myocardiac injury, and be beneficial to patients with early rehabilitation after operation.
出处
《安徽医科大学学报》
CAS
北大核心
2009年第1期92-95,共4页
Acta Universitatis Medicinalis Anhui
