乌司他丁对体外循环手术患者脑炎性反应的影响

目的：探讨乌司他丁对体外循环心脏手术患者脑炎性反应的影响。方法：选择24例择期行心脏瓣膜置换术患者，随机分为乌司他丁组(U组)和对照组(Ｃ组),每组12例。U组患者给予乌司他丁2.4×104U／kg，其中1.2×104U／kg于麻醉诱导后静脉注射，0.6×104U／kg加于体外循环预充液中随转流进入体内，0.6×104U／kg于主动脉开放前约5min加入体外循环机内。C组患者用等量容积的生理盐水代替。于麻醉后手术前（T1）、体外循环结束后60min(T2)、体外循环结束后6h（T3）同时抽取动脉血与颈静脉球血，测定肿瘤坏死因子α(TNFα)，白细胞介素6，8，10（IL-6，IL-8，IL-10），并计算颈静脉球血与动脉血各细胞因子之差△TNFα，△IL-6，△IL-8，△IL-10。结果：C组T2时动脉血TNFα，IL-6，IL-8，IL-10及△TNFα，△IL-8，△IL-10显著升高(P<0. 01)，T3时TNFα，IL-6，IL-8，IL-10及△TNFα，△IL-6，△IL-10明显升高(P<0. 01)，△IL-8亦升高(P<0. 05)； U组T2时IL-6，IL-8，IL-10显著升高(P<0.01)，TNFα，△TNFα，△IL-10亦升高(P<0.05)，T3时IL-6，IL-8，IL-10，△TNFα，△IL-8显著升高(P<0.01)，△IL-6，△IL-10亦升高(P<0.05)。T2时U组动脉血TNFα，IL-6及△TNFα，△IL-8低于C组(P<0.05)，动脉血IL-8显著低于C组(P<0.01)；T3时U组动脉血TNFα及△IL-6低于C组(P<0.05)，U组动脉血IL-6，IL-8显著低于C组(P<0.01)，动脉血IL-10与△IL-10高于C组(P<0.05)。结论：乌司他丁可以减轻体外循环手术患者全身和脑局部的炎性反应。

Effects of ulinastatin on cerebral inflammatory response during cardiopulmonary bypass

OBJECTIVE: To investigate the effects of ulinastatin (UTI) on cerebral inflammatory response during cardiopulmonary bypass (CPB). METHODS: Twenty-four NYHA II-III patients (13 males and 11 females) aged 23-45 years, undergoing elective cardiac valve replacement under hypothermic CPB were randomly divided into 2 groups: ulinastatin group (Group U, n=12) and control group (Group C, n=12). In group U, UTI (1.2 x 10(4) U/kg) was given intravenously after the induction of anesthesia, 0.6 x 10(4) U/kg UTI was added to the priming solution, and 0.6 x 10(4) U/kg UTI was given about 5 min before the aortic decamping. In Group C, normal saline was given instead of UTI. Internal jugular vein was cannulated and the catheter was advanced retrogradely till jugular bulb. Blood samples were taken simultaneously from artery and jugular bulb after induction of anesthesia (T1), 60 min (T2) and 6 h (T3) after discontinuation of CPB for determination of TNFalpha, IL-6, IL-8 and IL-10. The juguloarterial gradients of these cytokines (deltaTNFalpha, deltaIL-6, deltaIL-8, and deltaIL-10) were calculated. RESULTS: In Group C, arterial levels of TNFalpha, IL-6, IL-8, IL-10 at T2 and T3, deltaTNFalpha, deltaIL-8 and deltaIL-10 at T2, deltaTNFalpha, deltaIL-6 and deltaIL-10 at T3 significantly increased (P < 0.01). deltaIL-8 increased at T3 (P < 0.05). In Group U, arterial levels of IL-6, IL-8, IL-10 at T2, arterial levels of IL-6, IL-8,IL-L-10 and deltaTNFalpha, deltaIL-8 at T3 significantly increased (P < 0.01). Arterial levels of TNFalpha at T2 and T3, deltaTNFalpha, deltaIL-10 at T2, deltaIL-6 at T3 increased (P < 0.05). Arterial levels of TNFalpha, IL-6 and deltaTNFalpha, deltaIL-8 at T2, arterial levels of TNFalpha and deltaIL-6 at T3 in Group U were lower than those in Group C (P < 0.05). Arterial levels of IL-6 at T3, IL-8 at T2 and T3 in Group U were significantly lower than those in Group C (P < 0.01). Arterial levels of IL-10 and deltaIL-10 at T3 in Group U were higher than those in Group C (P < 0.05). CONCLUSION: Systemic and cerebral activation of inflammatory response during CPB can be alleviated by ulinastatin.