体外循环细胞因子和黏附分子的变化及干预性治疗

目的：通过观察体外循环细胞因子及黏附分子的变化，探讨体外循环期间乌司他丁的作用及临床意义。方法：选择择期在体外循环下行心内直视手术患者22例，随机分为乌司他丁组（W组）和对照组（C组），每组11例。乌司他丁组按1.2×104U/kg给乌司他丁，于麻醉诱导后劈胸骨前经静脉给予半量，另半量加入预充液中，经体外循环机转入体内。对照组用等量复方氯化钠代替。分别于诱导后切皮前（T1）﹑转流20min（T2）﹑停机1h（T3）﹑停机6h（T4）及停机24h（T5）抽取动脉血，测定肿瘤坏死因子-α（TNF-α），白细胞介素-6（IL-6），血浆可溶性细胞间黏附分子-1（sICAM-1）及可溶性P-选择素（sP-选择素）的浓度。结果：组内比较2组患者TNF-ɑ和IL-6的浓度在T2，T3，T4时均明显高于T1期(P<0.05)，W组在T5恢复到T1水平；2组之间比较C组TNF-α和IL-6的浓度在T2， T3， T4， T5时均明显高于W组(P<0.01)。组内比较2组患者sICAM-1和sP-选择素的浓度在T3，T4时均较T1明显升高(P<0.05)，到T5时sICAM-1和sP-选择素的浓度已下降，其中W组的sICAM-1已降至接近T1水平(P>0.05)；2组之间比较C组的sICAM-1和sP-选择素的浓度在T4， T5时明显高于W组(P<0.05)。结论：体外循环可引起细胞因子及黏附分子的表达上调，乌司他丁能抑制细胞因子的释放及黏附分子的表达，有利于减轻CPB所致的炎症反应。

Changes of cell adhesion molecules and proinflammatory cytokines during cardiopulmonary bypass and the effect of intervention

OBJECTIVE: To investigate the changes of the cell adhesion molecules and proinflammatory cytokines during cardiopulmonary bypass, and to observe the effect of intervention with ulinastatin. METHODS: Twenty-two ASA II-III patients (9 males, 13 females), aged 20-60 years, undergoing cardiac operation with CPB were randomly divided into 2 groups: the control group (Group C, n=11) and the ulinastatin group (Group W, n=11). In Group W, patient received ulinastatin 1.2 x 10(4) U/kg, and half of the dose was given intravenously after the induction of anesthesia, while the same amount of ulinastatin added into the primary solution. And in Group C, normal saline was given instead of ulinastatin. Blood samples were taken from radial artery before the operation (T1), 20 min after the initiation of CPB (T2), 1 h (T3), 6 h (T4 ), 24 h (T5) after the CPB for the determination of plasma TNF-alpha, IL-6, sICAM-1 and sP-Selectin concentrations. RESULTS: The concentrations of TNF-alpha, IL-6 increased significantly at T2-T4 in both groups compared with T1 (P < 0.05), and returned to the baseline level at Ts in Group W. The concentrations of TNF-alpha, IL-6 in Group C at T2-T5 were higher than that in Group W (P < 0.01). The concentrations of sICAM-1, sP-Selectin increased significantly at T3, T4 in both groups compared with that at T1 (P < 0.05). But at T5, the concentrations of sICAM-1, sP-Selectin decreased, especially in Group W the concentrations of sICAM-1, sP-Selectin returned to the baseline level. The sI-CAM-1, sP-Selectin concentrations in group C at T4, T5 were higher than that in group W (P < 0.05). CONCLUSION: Ulinastatin can reduce the increase of the cell adhesion molecules and proinflammatory cytokines during cardiopulmonary bypass and effectively weaken the inflammatory response to CPB.