乌司他丁可减轻全麻颈动脉内膜剥脱术患者的脑缺血/再灌注损伤

本研究拟观察乌司他丁减轻全身麻醉下,行颈动脉内膜剥脱术(CEA)的患者脑缺血再灌注损伤的有效性.将40例有症状的重度颈动脉狭窄,于全身麻醉下行单侧标准颈动脉内膜剥脱术的患者随机分为干预组与非干预组,每组20例.干预组在麻醉诱导前经静脉给予乌司他丁5×105 U,非干预组用等量生理盐水.分别于麻醉诱导后、颈动脉夹闭15 min、颈动脉开放15 min,以及术后第1,2,3天抽取患侧颈内静脉球部血液进行肿瘤坏子因子α(TNF-α)、丙二醛(MDA)检测;分别于麻醉诱导后、颈动脉夹闭15 min及开放15 min做动脉及颈内静脉球部血气分析;分别于麻醉诱导后及术后第1,2,3天抽取颈内静脉球部血液进行神经元特异性烯醇化酶(NSE)检测.干预组各时间点的TNF-α浓度均低于非干预组(P0.05),动脉-颈内静脉氧含量差值在颈动脉开放15 min时高于非干预组(P0.05),术后重症监护室驻留时间较非干预组降低38.7%((27.1α15.7)h vs.(44.1α29.6 h),P0.05).两组患者各时间点颈内静脉球部MDA和NSE含量无显著差异(P0.05).预防性给予乌司他丁能够减轻全麻CEA患者术中脑缺血/再灌注损伤性炎性反应,提高脑氧代谢能力,改善术后转归.

Pretreatment with Ulinastatin can Reduce Cerebral Ischemia/Reperfusion Injury during Carotid Endarterectomy under General Anesthesia

The aim of this prospective study was to assess the usefulness of pretreatment with ulinastatin to reduce cerebral ischemia/reperfusion injury during carotid endarterectomy under general anesthesia. Forty patients were randomized into the ulinastatin group and the control group. Patients in the ulinastatin group received a 500000 U dose of ulinastatin immediately before anesthesia induction. Participants in the control group were administered with equal normal saline. Blood samples were drawn from the ipsilateral jugular bulb before skin incision, at 15 min after clamping and 15 min after declamping individually, and daily postoperatively for 3 d for malondialdehyde （MDA）, tumor necrosis factor ~ （TNF-a） determination, before skin incision, at 15 min after clamping and 15 min after declamping for blood gas analysis, and before skin incision, daily postoperatively for 3 d for neuron-specific enolase （NSE） determination. Blood samples were drawn from the artery before skin incision, at 15 min after clamping and 15 min after declamping individually for blood gas analysis. Compared with the control group, the ulinastatin group had the lower concentration of TNF-ct at every time point （P〈0.05）, but the higher cerebral arteriovenous oxygen content difference at 15 min after declamping （P〈0.05）, and the decreased ICU stay of 38.7% （27.1±15.7 h vs. 44.1±29.6 h, P〈0.05）. There were no differences between the ulinastatin group and the control group in MDA and NSE （P〉0.05）. Pretreatment with ulinastatin was useful to prevent inflammatory response and to improve cerebral oxygen metabolism and outcomes after carotid endarterectomy.