乌司他丁对重症肌无力患者围术期炎性因子的影响

目的观察乌司他丁对重症肌无力患者围术期炎性因子的影响。方法 60例择期行胸腺扩大切除术的重症肌无力患者（OssermannⅠ-Ⅱb型）随机分为对照组（C组,n=30）和乌司他丁组（U组,n=30）。U组入手术室后即给予乌司他丁4000U/kg溶于20ml氯化钠注射液中,10min内缓慢静脉推注,然后以2000U.kg^-1.h^-1持续泵入至手术结束。对照组给予等量的生理盐水。两组分别于麻醉前（T1）、切皮时（T2）、手术开始后60min（T3）、术毕（T4）、术后60min（T5）抽取动脉血,用酶联免疫吸附（ELISA）法测定肿瘤坏死因子（TNF-a）、白细胞介素-6（IL-6）和白细胞介素-10（IL-10）的浓度。结果两组患者血浆TNF-a、IL-6、IL-10浓度在T2-T5各时间点与麻醉前比较均明显增加（P〈0.05-0.01）;U组患者血浆TNF-a、IL-6浓度在T2-T5各时间点明显低于C组,血浆IL-10浓度明显高于C组（P〈0.05-0.01）。结论乌司他丁能够抑制重症肌无力患者围术期促炎细胞因子TNF-a和IL-6的释放,促进抗炎细胞因子IL-10的释放,调节促炎细胞因子和抗炎细胞因子之间的平衡。

Effects of ulinastatin on inflammatory cytokins during perioperative period of patients with myasthenia gravis

Objective To observe the effects of ulinastatin on inflammatory cytokins during perioperative period of patients with myasthenia gravis.Methods 60 patients with myasthenia gravis （OssermannⅠ-Ⅱb） undergoing expand thymectomy were randomly divided into control group （group C,n = 30） and ulinastatin group （group U,n = 30）. Ulinastatin group patients received intravenous injection of ulinastatin 4000 U/kg in 20 ml physiological saline after enter operating room immediately and pumped ulinastatin 2 000 U·kg-1·h-1to end of operation continuously. Control group patients received same volume of normal saline. Blood samples were taken from radial artery for determination of plasma TNF-a,IL-6,IL-10 concentrations before induction of anesthesia （T1）,skin incision （T2）,60 min during operation （T3）,the end of operation（T4） and 60min after operation. All of these were estimated by enzyme-linked immunosorbent assay （ELISA）.Results The level of plasma TNF-a,IL-6 and IL-10 significantly increased at T2-T5 compared with T1 in both groups （P〈0.05 or 0.01）. However,the plasma concentrations of TNF-a,IL-6 were markedly lower while the level of IL-10 was significantly higher in group U than those in group C at T2-T5 （P〈0.05-0.01）.Conclusion Ulinastatin can regulate the balance of proinflammatory cytokines and anti-inflammatory cytokines by reduce the level of TNF-a,IL-6 and enhance the level of IL-10 during perioperative period of patients with myasthenia gravis.