不同剂量乌司他丁对体外循环患者中性粒细胞核因子-κB活性影响.docVIP

不同剂量乌司他丁对体外循环患者中性粒细胞核因子-κB活性影响 　 作者：李建立，赵砚丽，韩广彦，赵志勇，闫志军，李喜龙 【摘要】 目的 观察不同剂量乌司他丁对体外循环(CPB)患者中性粒细胞(PMN)核因子κB(NF-κB)活性的影响。方法 选择在CPB下行心脏直视手术的法洛四联症患儿60例，随机分成乌司他丁1组(U1组)、乌司他丁2组(U2组)和对照组(C组),每组20例。U1组给乌司他丁1.0万U/kg,U2组给乌司他丁2.0万U/kg,用生理盐水稀释至20 ml,于麻醉诱导后切皮前经中心静脉推注半量,另半量加入预充液中。C组以等量生理盐水替代, 用法同上。分别于麻醉后手术前(T1)、CPB开始后30 min(T2)、CPB停止后30 min(T3)、4 h(T4)和24 h(T5)抽取桡动脉血3 ml,分离中性粒细胞，用ELISA法检测NF-κB活性。结果 三组患者PMN NF-κB 活性在CPB开始后均逐渐升高,CPB停止后30 min达到峰值,之后逐渐下降，但在CPB停止后24 h三组患者PMN NF-κB活性均依然高于术前水平; U1组、U2组NF-κB 活性在T2～T5均低于C组(Plt;0.05);U2组NF-κB活性在T2～T4均低于U1组(Plt; 0.05)。结论 乌司他丁可以降低CPB患者PMN NF-κB的活性，且2.0万U/kg组对NF-κB活性的抑制作用比1.0万U/kg组更强。 【关键词】 乌司他丁; 体外循环; 中性粒细胞; 核因子-κB 　　Abstract: OBJECTIVE To study the effects of different doses of ulinastatin on the NF-κB activity of polymorphonuclear neutrophils in patients with cardiopulmonary bypass(CPB) .METHODS 60 congenital tetralogy of Fallot patients were randomly divided into three groups of 20 each,ulinastatin (U1) group:10 000U/kg,ulinastatin (U2) group:20 000U/kg,control (C) group used equal normal saline.3 milliliter radial artery blood was collected after induction of anesthesia(T1), 30 min after start of CPB(T2),30 min(T3),4 hours(T4) and 24 hours(T5) after end of CPB. PMN NF-κB activity was tested in ELISA.RESULTS The value of PMN NF-κB activity showed a progressive rise after the begin of CPB，the climax value of PMN NF-κB activity was got T3，then it declined. But PMN NF-κB activity at T5 was still higher than that T1 . The PMN NF-κB activity in treatment group was lower than that in control group T2,T3,T4 and T5. The PMN NF-κB activity in U2 group was lower than that in U1 group T2,T3 and T4.CONCLUSION Ulinastatin can reduce the activity of PMN NF-κB,and the inhibition action of U2 group is better than U1 group in patients undergoing CPB. 　　Key words： Ulinastatin; Cardiopulmonary bypass;Polymorphonuclear neutrophils;NF-κB 　　体外循环(cardiopulmonary bypass,CPB)可触发一系列全身炎症反应, CPB中许多因素如血液与CPB管道直接接触,手术创伤,器官缺血再灌注,术中体温的改变等,均可引起全身炎症反应[1]。而核因子-κB ( nuclear