盐酸戊乙奎醚对体外循环机体炎症反应的影响

目的研究盐酸戊乙奎醚对体外循环(CPB)机体炎症反应的影响。方法选择40例择期行体外循环瓣膜置换术的风湿性心脏病患者,按随机数字表分为盐酸戊乙奎醚组(P组)和生理盐水对照组(C组),每组20例。P组诱导和预充液中使用盐酸戊乙奎醚,对照组则使用生理盐水,分别于麻醉诱导前(T0),CPB开始后30min(T1),主动脉开放10min(T2),CPB结束后2h(T3),抽取动脉血,测定血浆白介素(IL)-6、肿瘤坏死因子(TNF)-α的浓度,并观察术后肺炎发生率、全身炎症反应综合征(SIRS)发生率、有无谵妄等临床指标。结果组内比较,P组和C组在T2、T3时,IL-6浓度均高于T0、T1(P<0.05);P组TNF-α浓度在T3时低于T1和T2(P<0.05)。组间比较,在T2、T3时,P组IL-6浓度低于C组(P<0.05);TNF-α浓度各时间点差异无统计学意义(P>0.05)。肺炎发生率和SIRS发生率P组均低于C组(P<0.05)。结论应用盐酸戊乙奎醚能一定程度上抑制细胞因子的释放,对CPB术后SIRS和肺部并发症有一定的防治作用。

Effect of Penehyclidine Hydrochloride in Systemic Inflammatory Response Syndrome Caused by Cardiopulmonary Bypass

Objective To investigate whether Penehyclidine hydrochloride has effect on the inflammatory process and leukocytes in cardiac surgery patients undergoing cardiopulmonary bypass.Methods 40 rheumatic heart disease patients undergoing CPB were randomly divided into Penehyclidine hydrochloride(P) group and control(C) group(20 patients in each group).In group P,intravenous drip of 0.01 mg/kg of Penehyclidine hydrochloride injection was given before anesthesia,and 0.015 mg/kg of Penehyclidine hydrochloride was added into initial volume of CPB.While in control group,0.9% NaCl solution was given instead of injection as a placebo.Blood samples were taken before anesthesia(T0),30 min after CPB(T1),10 min after aortic off-clamping(T2) and 2 hours when CPB was over(T3).Interleukin-6(IL-6),tumornecross alpha(TNF-α) levels were detected by ELISA.The morbility of pneumonia and SIRS caused by CPB was also evaluated.Results At T2 and T3,the IL-6 level was higher than T0 and T1 both in group C and group P(P<0.05).At T2 and T3,the IL-6 level in group C was higher than that of group P(P<0.05).The TNF-a level at T3 was lower than at T1 and T2 in group P(P<0.05).There was no significant difference between group P and group C at each time point(P>0.05).The morbility of pneumonia and SIRS was higher in group C(P<0.05).Conclusion Penehyclidine hydrochloride can decrease the levels of proinflamnlatory cytokines in plasma and therefore attenuate the morbility of pneumonia and SIRS caused by CPB.