盐酸戊乙奎醚对心脏手术围术期应激反应的影响

目的观察盐酸戊乙奎醚对围术期应激反应的影响。方法 40例心肺转流（CPB）下行心脏瓣膜置换术患者,随机均分为盐酸戊乙奎醚组（P组）和对照组（C组）。P组CPB前10 min颈内静脉注射盐酸戊乙奎醚0.05 mg/kg,C组给予等容量生理盐水。分别于CPB前（T₁）、主动脉开放10 min（T₂）、停CPB即刻（T₃）、术后2 h（T₄）、6 h（T₅）、18 h（T₆）采集中心静脉血,测定血浆白细胞介素-6（IL-6）、白细胞介素-10（IL-10）水平,并进行静脉血气分析和血糖、血乳酸监测。结果 T₂、T₃、T₅时P组血糖和乳酸浓度明显低于C组（P<0.05）,T₃～T₅时P组血浆IL-6水平明显低于C组（P<0.05）。结论预先给予盐酸戊乙奎醚0.05 mg/kg可减轻围CPB期应激反应,可能与整体调控神经-内分泌-免疫系统使其趋于平衡有关。

Effect of penehyclidine hydrochloride on stress reaction during cardiopulmonary bypass in patients undergoing open heart surgery

Objective To observe the effect of penehyclidine hydrochloride（PHC） on stress reaction during cardiopulmonary bypass in patients undergoing open heart surgery.Methods Forty patients undergoing heart valve replacement with cardiopulmonary bypass were randomly divided into two groups with 20 cases each:penehyclidine hydrochloride group（group P） and control group （group C） respectively.Patients in group P were injected PHC 0.05 mg/kg 10 min before CPB from the internal jugular vein.Patients in group C were injected the same volume saline.Jugular vein blood was drawn following 6 time points:before CPB（T₁）,10 min after aortic cross clamp release（T₂）, immediately at the end of CPB（T₃）,2 h after operation（T₄ ）,6 h after operation（T₅）,18 h after operation（T₆）.The density of blood cytokine levels（IL-6,IL-10） were detected by enzyme-linked immunosorbent assay.Blood samples were taken for analysis of blood gas,serum glucose and lactate concentration at every time point.Results In group P,the concentrations of blood glucose and lactate were significantly lower at T₂,T₃,T₅ than those in group C（P < 0.05）.In group P,the concentration of IL-6 was significantly lower at T₃-T₅ than those in group C（P<0.05）. Conclusion 0.05 mg/kg penehyclidine hydrochloride preconditioning before CPB could depress stress reaction by regulating nervous system,endocrine system and immunity system.