乌司他丁与甲泼尼龙对体外循环患者炎症反应的影响

发布时间：2018-11-03 14:18

【摘要】：目的比较乌司他丁与甲泼尼龙对体外循环(CPB)患者炎症反应的影响。方法择期于CPB下行心脏瓣膜置换术患者60例,随机分为三组,每组20例。三组麻醉和CPB方法相同,乌司他丁组给予乌司他丁1.2×104 U·kg-1,甲泼尼龙组给予甲泼尼龙2.5 mg·kg-1,对照组给予氯化钠注射液。分别于麻醉诱导后切皮前(T1),CPB开始后1 h(T2),CPB结束后1 h(T3)、6 h(T4)、24 h(T5)及48 h(T6)检测血清白细胞介素(IL)6、10和肿瘤坏死因子α(TNF-α)浓度,并记录比较术后气管插管时间、ICU滞留时间等。结果与T1时比较,三组血清中IL-6、TNF-α浓度在T2~T5时均增加(P0.05),T6时与T1时无明显差异(P0.05);IL-10浓度在T2~T4时增高(P0.05),T5、T6时降至T1时水平。T2~T5时,乌司他丁组和甲泼尼龙组IL-6、TNF-α浓度低于对照组(P0.05),T2~T4时的IL-10浓度高于对照组(P0.05),而乌司他丁组和甲泼尼龙组各时点差异均无显著意义(P0.05)。与对照组比较,甲泼尼龙组和乌司他丁组术后发热日数、ICU滞留时间、气管插管时间、总住院时间及术后住院时间均缩短(P0.05),甲泼尼龙组和乌司他丁组间无显著差异(P0.05)。结论乌司他丁和甲泼尼龙均可以抑制CPB患者IL-6、TNF-α的产生并促进IL-10的释放,调节促炎-抗炎反应平衡,两者作用类似。
[Abstract]:Objective to compare the effect of ulinastatin and methylprednisolone on inflammatory response in (CPB) patients undergoing cardiopulmonary bypass (CPB). Methods 60 patients with cardiac valve replacement were randomly divided into three groups, 20 patients in each group. The anesthesia of the three groups was the same as that of CPB. Ulinastatin 1.2 脳 104U kg-1, methylprednisolone was given to the control group with sodium chloride injection. Before skin incision after anesthesia induction (1 h after T1), CPB (1 h after T 2), CPB), 6 h (T 4), respectively, before anesthesia induction, 1 h (T 3) and 6 h (T 4) after anesthesia induction, respectively. Serum levels of interleukin (IL) 6 10 and tumor necrosis factor 伪 (TNF- 伪) were measured at 24 h (T 5) and 48 h (T 6), and the time of tracheal intubation and ICU retention were recorded. Results compared with T1, the concentration of IL-6,TNF- 伪 in serum of the three groups increased at T2~T5 (P0.05), but there was no significant difference between T6 and T1 (P0.05). The concentration of IL-10 increased at T2~T4 (P0.05), decreased to T1 at T5T6. At T2~T5, IL-6,TNF- 伪 concentration in ulinastatin group and methylprednisolone group was lower than that in control group (P0.05). The concentration of IL-10 in T2~T4 group was higher than that in control group (P0.05), but there was no significant difference at each time point between ulinastatin group and methylprednisolone group (P0.05). Compared with the control group, the days of fever, the retention time of ICU, the time of endotracheal intubation, the total hospitalization time and the postoperative hospitalization time were shortened in methylprednisolone group and ulinastatin group (P0.05). There was no significant difference between methylprednisolone group and ulinastatin group (P0.05). Conclusion both ulinastatin and methylprednisolone can inhibit the production of IL-6,TNF- 伪, promote the release of IL-10 and regulate the balance of pro-inflammatory and anti-inflammatory response in patients with CPB.
【作者单位】：青岛大学附属医院麻醉科;
【分类号】：R614

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