抑肽酶和乌司他丁在体外循环中抗炎作用的比较

目的 比较抑肽酶和乌司他丁在心脏手术体外循环(extracorporeal circulation,ECC)中的抗炎作用.方法 选择60例心脏瓣膜置换手术患者,ASAⅡ-Ⅲ级,按随机数字表法分为乌司他T组(U组)、抑肽酶组(A组)和空白对照组(C组),每组20例.于ECC前15 min(T1)、开放升主动脉后10 min(T2)、ECC结束后30 min(T3)、ECC结束后60 min(T4)4个时点取颈内静脉血测定下列指标:血浆IL-6、IL-8、IL-10及肿瘤坏死因子-α(TNF-α)浓度.分析3组各时点炎性因子的变化.结果 3组血浆IL-6、IL-8、IL-10、TNF-α浓度在T2、T3、T4时点均明显高于T1时点(P<0.01);血浆IL-6、IL-8、TN-α浓度在T1、T2、T3、T4时点U组明显低于A、C组(P<0.05,P<0.01),A组明显低于C组(P<0.05);血浆IL-10浓度在T2、T3、T4时点U组、A组明显高于C组(P<0.05,P<0.01),U组明显低于A组(P<0.05).结论 乌司他丁和抑肽酶在ECC中都能抑制炎性因子的产生,并可上调抗炎因子表达.乌司他丁在抑制炎性因子的产生方面强于抑肽酶,而抑肽酶上调抗炎因子表达的作用优于乌司他丁.两者都可有效抑制ECC诱发的炎性反应.

Comparative study on ulinastatin and aprotinin on anti-inflammatory in patients undergoing extracorporeal circulation

Objective To compare the effects of aprotinin and ulinastatin on antai-inflammatory in patients who undergoing cardiac valve replacement with extracorporeal circulation(ECC).Methods Sixty ASA Ⅱ to Ⅲ patients who underwent cardiac vavle replacement from June 2006 to March 2008 were randomly divided into 3 groups:ulinastatin group(group U,n=20),aprotinin group(group A,n=20)and control group(group C.n=20).Haft dose of ulinastatin(2×10~4 U/kg)and aprotinin(56 U/kg)was given to corresponding groups 10 min before ECC.and the left half was added into priming solution,and control groups received normal saline at the same volume.The intravenous blood samples were taken from 15 min before ECC(T1),10 min after opening ascending aorta(T2).30 min after discontinuation of ECC(T3)and 60 min after discontinuation of ECC(T4).and the plasma concentrations of IL-6,IL-8,IL-10 and TNF-α were detected to analyze the changes of the inflammatory factors in each group at 4 time points.Results The plasma concentrations of IL-6.IL-8.IL-10 and TNF-α were significantly higher at time points T2,T3 and T4 than at T1.The plasma concentrations of IL-6.IL-8 and TNF-α at time points T2,T3 and T4 were significantly lower in group U than group A and group C(P<0.05,0.01),and these concentrations in Group A were lower than in group C(P<0.05).The plasma concentration of IL-10 at time points T2,T3 and T4 in group U and group A were significantly higher than in group C(P<0.05,0.01),with the former group significantly lower than the later (P<0.05).Conclusion Ulinastatin and aprotinin inhibits the inflammatory factors induced by ECC,and improves the expressions of anti-inflammatory factors.Ulinastatin is more effective than aprotinin in inhibiting the inflammatory factors.However.aprotinin is more effective than ulinastatin in upregulating the expressions of anti-inflammatory factors.Both of them can effectively suppress ECC-induced inflammatory response.