乌司他丁及氨甲环酸联合应用抑制瓣膜置换术患者炎性因子及粒细胞弹性蛋白酶的临床研究

目的研究乌司他丁和氨甲环酸单独或联合应用在体外循环(CPB)心脏瓣膜置换手术中对炎性细胞因子及中性粒细胞弹性蛋白酶(NE)的影响。方法选择择期体外循环下行瓣膜置换术患者120例,随机分为空白对照组(C组)、氨甲环酸组(T组)、乌司他丁组(U组)以及联合用药(氨甲环酸+乌司他丁)组(D组),每组30例,分别给予生理盐水、氨甲环酸、乌司他丁及联合应用氨甲环酸及乌司他丁。于麻醉诱导后(T1)、转流开放升主动脉后(T2)、停机1h(T3)、停机24h(T4)4个时点经桡动脉抽取动脉血,测定血浆肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)和NE的浓度。结果各组患者血浆TNF-α、IL-6和NE的浓度,在T2～T4时点与CPB前比较均显著增加(P<0.05);T2～T4时点U组和T组血浆TNF-α和IL-6浓度显著低于其他各组(P<0.05)。结论乌司他丁能抑制CPB过程中炎性介质的释放,减轻体外循环期间炎症反应。氨甲环酸具有轻微抗炎性反应。在心脏瓣膜置换手术中联合应用乌司他丁和氨甲环酸可抑制炎性反应。

Combined ulinastatin and tranexamic acid provides beneficial effects by inhibiting inflammatory and fibrinolytic response in patients undergoing heart valve replacement surgery

Objective To investigate the effect of ulinastatin and tranexamic acid administered alone or in combination on inflammatory cytokines and neutrophil elastase(NE) in patients undergoing heart valve replacement surgery during cardiopulmonary bypass(CPB).Methods One hundred and twenty patients undergoing heart valve replacement surgery during CPB were randomly assigned into 4 groups of 30 patients each:blank control group(Group C),tranexamic acid group(Group T),ulinastatin group(Group U) and tranexamic acid-ulinastatin combination group(Group D).Physiological saline,tranexamic acid,ulinastatin and a combination of tranexamic acid and ulinastatin were given to the groups respectively.Arterial blood was collected from the radial artery at four time points,that is,after induction of anesthesia(T1),unclamping the ascending aorta(T2),at 1 h(T3) and 24 h(T4) after CPB.The levels of plasma tumor necrosis factor-alpha(TNF-α),interleukin 6(IL-6),NE were observed and recorded.Results The plasma TNF-α,IL-6 and NE levels significantly increased in patients from all 4 groups at time points of T2,T3 and T4 in comparison to those before CPB(P < 0.05),while the plasma TNF-α and IL-6 levels in Groups U and D were significantly lower than those in other 2 groups(P < 0.05).Conclusions Ulinastatin inhibits the release of inflammatory factors and reduces the inflammatory response during CPB.Tranexamic acid exhibits a mild anti-inflammatory response.