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目的观察乌司他丁对心肺转流(CPB)下瓣膜置换术患者血浆S-100β蛋白、炎性细胞因子及认知功能的影响。方法择期行瓣膜置换术患者40例,随机均分为乌司他丁组(U组)和对照组(C组)。U组于切皮前静脉注射乌司他丁10 000 U/kg,并在预充液中加入10 000 U/kg;C组给予等容量生理盐水。于给药前(T1)、CPB结束后即刻(T2)、2 h(T3)、6 h(T4)及24 h(T5)抽取颈内静脉血测定血浆IL-6、TNF-α浓度及S-100β蛋白;于麻醉前1 d和术后1、3、7 d对患者进行评分并判断是否发生术后认知功能障碍(POCD)。结果与T1时比较,T2~T5时两组血浆S-100β蛋白及IL-6、TNF-α浓度均升高(P<0.05);与C组比较,U组中的S-100β蛋白及IL-6、TNF-α浓度显著降低(P<0.01);U组2例、C组7例发生POCD(P<0.05)。结论乌司他丁可减轻瓣膜置换术患者CPB时炎性介质的释放,降低患者术后POCD的发生率。
Objective To investigate the effect of ulinastatin on plasma S-100β protein, inflammatory cytokines and cognitive function in patients undergoing valve replacement under cardiopulmonary bypass (CPB). Methods Forty patients undergoing valvular replacement were randomly divided into ulinastatin group (U group) and control group (C group). In group U, ulinastatin 10 000 U / kg was injected intravenously before incision and 10 000 U / kg was added to the priming solution. Group C was given normal saline. Plasma concentrations of IL-6, TNF-α and plasma S were measured before treatment (T1), immediately after CPB (T2), 2 h (T3), 6 h (T4) and 24 h -100β protein. Patients were scored 1 day before anesthesia and 1, 3, 7 days after operation to determine whether postoperative cognitive impairment (POCD) occurred. Results Compared with T1, the concentrations of S-100β protein, IL-6 and TNF-α in T2 ~ T5 group were significantly increased (P <0.05). Compared with C group, the levels of S-100β protein and IL (P <0.01). There were 2 cases in U group and 7 cases in C group (P <0.05). Conclusion Ulinastatin can reduce the release of inflammatory mediators during CPB and reduce the incidence of postoperative POCD in patients undergoing valvular replacement.