乌司他丁对心肺转流下心脏手术患者炎症因子及认知功能的影响

目的:探索乌司他丁(UTI)对心肺转流(CPB)下心脏手术患者炎症因子及认知功能的影响。方法:选择自2010年5月至2014年9月我院收治的CPB瓣膜置换手术患者60例,按照随机数表法将患者分成对照组和观察组,每组30例。观察组患者在麻醉诱导后静脉泵入1.2×10~4U/kg UTI,在CPB结束前5 min从体外管道内给予0.6×10~4U/kg UTI,对照组患者给予等量的生理盐水。对比两组CPB前(T0)、CPB开始后1 h(T1)、CPB结束后1 h(T2)、术后4 h(T3)及术后24 h(T4)的血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6/10(IL-6/10)、中性粒细胞弹性蛋白酶(NE)、星形胶质细胞S100蛋白的β亚型(S100β)、超氧化物歧化酶(SOD)和丙二醛(MDA),在术前1 d和术后7 d时,采用简易精神状态检查表(MMSE)对患者进行神经精神功能测试,并评价患者的术后认知功能障碍(POCD)的发生率。结果:与T0相比,两组患者T1-T4的TNF-α、IL-6、NE、S100β、MDA水平明显升高,且观察组显著低于对照组,而两组IL-10、SOD水平显著下降,观察组显著高于对照组(P0.05)。术后7d,两组患者MMSE评分均明显高于术前1 d,且观察组显著高于对照组(P0.05);观察组POCD的发生率明显低于对照组(P0.05)。结论:UTI可以有效降低CPB下行瓣膜置换术患者的炎症因子水平,并改善患者的POCD,对于临床用药具有指导意义。

Influence of Ulinastatin on Inflammatory Factors and Cognitive Function inPatients with Cardiac Surgery under Cardiopulmonary Bypass

Objective:To explore the influence of ulinastatin (UTI) on the inflammatory factors and cognitive function in patientswith cardiac surgery under cardiopulmonary bypass (CPB).Methods:A total of 60 patients, who underwent CPB valvular replacementsurgery in Nanchong Central Hospital of Sichuan Province fromMay 2010 to September 2014, were randomly divided into control group(n=30) and observation group(n=30). The observation group was pumped into 1.2× 104U/kg UTI through vein after anesthesia induction,and given 0.6 × 104U/kg UTI from vitro pipeline 5 min before the end of CPB, while the control group was given the same amount ofsaline solution. The serumtumor necrosis factor-alpha(TNF-alpha),interleukin-6/10(IL-6/10), neutrophil elastase(NE), astrocytes S100 proteins betaisoforms(S100beta), superoxide dismutase(SOD) and malondialdehyde(MDA) in the two groups before CPB(T0), 1 h before CPB(T1), 1hafter CPB(T2), 4 h after CPB(T3) and 24 h after CPB(T4) were compared respectively. The mini mental state examination(MMSE) Thenervous mental functions of the patients 1 d before surgery and 7 d after surgery were tested by the mini mental state examination(MMSE); and the incidence of postoperative cognitive function (POCD) was evaluated.Results:Compared with the T0, the levels ofTNF-alpha, IL-6, NE, S100beta and MDA in the two groups at T1-T4 significantly increased, and the above indexes of the observation groupwere significantly lower than those of the control group; meanwhile, the levels of IL-10 and SOD significantly decreased, but the aboveindexes of the observation group were significantly higher than those of control group(P<0.05). MMSE scores in the two groups 7 d aftersurgery were significantly higher than 1 d before surgery, in addition, the MMSE score of the observation group was significantly higherthan that of the control group (P<0.05). The incidence of POCD in the observation group was obviously lower than that in the controlgroup (P<0.05).Conclusion:UTI can effectively reduce the inflammatory factor levels of patients undergoing CPB valvular replacementsurgery, and improve the POCD status, which gives a guiding significance to clinical medication.