氨力农及抑肽酶对瓣膜置换术围手术期炎症细胞因子释放影响的随机对照研究

目的　了解氨力农及抑肽酶对瓣膜置换术患者围手术期全身炎症应答的影响。方法　将接受瓣膜置换手术的 2 4例患者随机分为对照组 (A组 ,n=8)、抑肽酶组 (B组 ,n=8)和氨力农加抑肽酶组 (C组 ,n=8)。 A组患者不使用抑肽酶 ;B组患者于预充液中加入抑肽酶 30 0万单位 ;C组患者开胸前按 1mg/ kg静脉注射氨力农 ,然后以 8μg/ (kg· m in)静脉泵入直到停机 ,并在转流前将抑肽酶 30 0万单位加入预充液。分别于术前、停机、停机后 1小时及术后 1天抽取患者外周血 ,用 IL - 6和 IL - 8EL ISA试剂盒双抗体夹心 EL ISA法测定 IL - 6和 IL - 8。结果　体外循环术前 ,三组患者血浆中的 IL - 6和 IL - 8水平无明显差异 (P>0 .0 5 )。体外循环术后 ,三组患者血浆中 IL - 6和 IL - 8水平均明显升高 (P<0 .0 5 ) ,术后 1天虽仍高于术前 ,但差异无显著性 (P>0 .0 5 )。停机后 1小时的 IL - 6水平 ,B组低于 A组 ,C组低于 B组 ,但这种差异无统计学意义 (P>0 .0 5 )。 B组及 C组停机后的 IL - 8水平也低于 A组同期水平 ,C组在此时间点和停机后 1小时亦低于 B组和 A组 ,但这些差异亦无统计学意义 (P>0 .0 5 )。结论　尽管氨力农和抑肽酶均有抗炎症的效应 ,但是仅在预充液中加入抑肽酶或在此基础上联合应用氨力农 ,均难以完全抑

Randomized Controlled Trial for the Effect of Amrinone and Aprotinin on Proinflammatory Cytokine Release in Patients with Prosthetic Valve Replacement during Perioperative Period

Objective　To explore the effect of amrinone and aprotinin on whole-body inflammatory response in the patients with prosthetic valve replacement during perioperative period. Methods　24 patients undergoing prosthetic valve replacment were randomized to control group (group A, n=8) , aprotinin group (group B, n=8) and amrinone combined with aprotinin group (group C, n=8). In the aprotinin group, 3×106 of aprotinin was added to the priming solution of the extracorporeal circulation (ECC). In the amrinone combined with aprotinin group 3×106 of aprotinin was added to the priming solution of the ECC and amrinone began with a bolus of 1mg/kg followed by a maintenance infusion of 8μg/(kg*min). The control group received an equivalent prime volume without aprotinin. Venous blood samples were drawn before the operation, at the end of ECC, 1 hour after the end of ECC, and one day after the operation respectively. Enzyme-linked immunosorbent assay techniques were used to measure each of the cytokines. Results　Before ECC, there were no differences of the levels of IL-6 and IL-8 among groups (P>0.05). After ECC, the levels of IL-6 and IL-8 increased significantly in all groups (P<0.05). The levels on day one after the operation were still higher than those before the operation in all groups (except the level of IL-8 in group C), but no statistical significance was observed. (P>0.05). At 1 hour after the end of ECC, the level of IL-6 in group B was lower than that in group A, and the level of IL-6 in group C was lower than that in group B, but there was no statistically significant difference (P>0.05）；At the end of ECC, the level of IL-8 in group B was lower than that in group A and the level of IL-8 in group C was lower than that in group B, but no significant difference was noted (P>0.05). It was also observed that the level of IL-8 was lower in group C than group A or B at 1 hour after the end of ECC. Conclusion　Although amrinone and aprotinin have antiinflammatory activity, but pump prime only aprotinin or aprotinin combined with amrinone may fail in preventing proinflammatory cytokine release (IL-6, IL-8) completely in patients with prosthetic valve replacement during ECC perioperative period.