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1、烏司他丁對體外循環(huán)心內(nèi)直視手術(shù)中炎性細(xì)胞因子的影響【摘要】 目的觀察烏司他丁在體外循環(huán)心內(nèi)直視手術(shù)中對炎性細(xì)胞因子水平的影響。方法30例體外循環(huán)心內(nèi)直視手術(shù)患者隨機(jī)分為烏司他丁組(U)和對照組(C),每組各15例。烏司他丁組(U)總量給予烏司他丁12000IU/kg,分別在體外循環(huán)前靜脈滴入半量,體外循環(huán)機(jī)內(nèi)加入半量。對照組(C)用等量的生理鹽水。分別在切皮前(T1)、體外循環(huán)開始后30min(T2)、體外循環(huán)停止(T3)、體外循環(huán)結(jié)束后2h(T4)、體外循環(huán)結(jié)束后4h(T5)、體外循環(huán)結(jié)束后24h(T6)采集血標(biāo)本,測定血清中的腫瘤壞死因子(TNF-α)、白細(xì)
2、胞介素-2(IL-2)、白細(xì)胞介素-6(IL-6)、白細(xì)胞介素-8(IL-8)、白細(xì)胞介素-10(IL-10)。結(jié)果兩組T2、T3、T4、T5、T6各時間點TNF-α、IL-2、IL-6、IL-8、IL-10均明顯高于T1(P<0.01或P<0.05),而U組TNF-α、IL-2、IL-6、IL-8明顯低于C組(P<0.01或P<0.05),IL-10均明顯高于C組(P<0.01或P<0.05)。結(jié)論體外循環(huán)導(dǎo)致白細(xì)胞激活,大量炎性介質(zhì)釋放和自由基產(chǎn)生,激發(fā)全身炎癥反應(yīng)綜合癥。烏司他丁應(yīng)用于體外循環(huán)心內(nèi)直視手術(shù)中可以減少TNF-α、IL-2、IL-6、IL-8的釋
3、放,促進(jìn)抑炎細(xì)胞因子IL-10的分泌,從而減輕有效地降低由于CPB引發(fā)的炎癥反應(yīng),減輕心肌的缺血再灌注損傷,起到保護(hù)心肌的作用。【關(guān)鍵詞】烏司他丁體外循環(huán)炎性細(xì)胞因子8 Abstract:ObjectiveToobserveeffectsofulinastationoninflammatoryfactorsduringCPBforopen-heartsurgery.Methods30patientsscheduledforselectivecardiopulmonarybypass(CPB)foropen-heartsurgerywererandomlydivi
4、dedintotwogroups:ulinastationgroup(U)andcontrolgroup(C),15casesineachgroup.Ulinastationgroup(U)totalquantitytogiveulinastation12000IU/kg.Halfquantityisdrippedintotheveinbeforetheexternalcirculation,andtheexternalcirculationwithintheaircraftrespectively.Controlgroup(C)usestheisometrict
5、hephysiologicalsaline.Gatherbloodspecimenatsuchtimesasbeforetheskiniscut(T1),30minaftertheexternalcirculationstarts(T2),whentheexternalcirculationstops(T3),2haftertheexternalcirculationfinishes(T4),4haftertheexternalcirculationends(T5),24haftertheexternalcirculationends(T6),anddetermi
6、nebloodserumtumornecrosisfactor(TNF-α),interleukin-2(IL-2),interleukin-6(IL-6),interleukin-8(IL-8),andinterleukin-10(IL-10).ResultsTwogroupsofT2,T3,T4,T5,theT6varioustimeselectTNF-α,IL-2,IL-6,IL-8,IL-10areobviouslyhigherthanT1(P<0.01orP<0.05),butUgroupofTNF-α,IL-2,IL-6,IL-8arelo
7、werthanCgroup(P<0.01orP<0.05).8IL-10isobviouslyhigherthanCgroup(P<0.01orP<0.05).ConclusionsExternalcirculationcausestheactivationofwhitebloodcell,themassiveinflammatorymediumrelease,thefreeradicalproduction,andthewholebodyinflammationresponsesyndrome.Ulinastationtoapplyinv
8、itrof