摘要
目的探讨体外循环心脏手术中蛋白酶抑制剂对围术期白细胞介素-8(IL-8)、全身炎症反应综合征(SIRS)评分及白细胞计数和分类的影响。方法 300例择期体外循环冠脉旁路移植术或瓣膜置换术患者,随机分为2组各150例。试验组于麻醉诱导后、肝素化后以及鱼精蛋白中和后,分别给予乌司他丁各100万单位,对照组则给予等量生理盐水。2组分别于手术开始前(T1)、手术结束即刻(T2)、术后8 h(T3)、术后16 h(T4)、术后24 h(T5)、术后48 h(T6)和术后72 h(T7)使用ELISA方法检验血浆IL-8浓度、评估患者SIRS评分并检验白细胞计数和中性粒细胞百分比。结果 IL-8浓度自T2即开始显著升高。在2组中的达峰时间分别为T4和T5。至术后72 h,试验组IL-8浓度降至术前水平,对照组IL-8浓度仍显著高于术前水平。自T3至T7试验组IL-8浓度均显著低于对照组。SIRS评分自T2开始升高,至T3达到峰值后逐渐下降。至T7,SIRS评分仍显著高于术前水平。自T3至T6,试验组SIRS评分始终显著低于对照组。白细胞计数自T2即显著升高,至T3达到峰值,随后逐渐下降。中性粒细胞比例自T2即显著升高,且持续至T7未有显著下降。自T3至T6,试验组白细胞计数显著低于对照组,自T3至T7,试验组中性粒细胞百分比显著低于对照组。结论乌司他丁可显著降低体外循环心脏手术围术期IL-8浓度、SIRS评分及白细胞计数和中性粒细胞比例。
Objective To evaluate the impact of protease inhibitor on interleukin-8,systemic inflammatory response syndrome（SIRS） score and white blood cell count and classification in patients receiving cardiac surgery with extracorporeal circulation.Methods A total of 300 elective patients receiving on-pump coronary artery bypass grafting or valve replacement were randomly assigned to two groups： trial group（n=150） and control group（n=150）.The patients in trial group was administered ulinastatin 1 000 000 units after induction,heparinization and neutralization and the control group normal saline.At the time point of before incision（T1）,at the end of the operation（T2）,8 hours（T3）,16 hours（T4）,24 hours（T5）,48 hours（T6） and 72 hours（T7） post-operation,plasma concentration of interleukin-8,leucocyte count and percentage of neutrophil were assayed and SIRS score was evaluated in both groups.Results The plasma interleukin-8 concentration was increased significantly at T2 and reached its peak at T4 in the trial group and T5 in the control group,and then declined.At T7,the concentration was comparable with the baseline value in the trial group,but still significantly higher in the control group.At T3-T7,the concentration was significantly lower in the trial group than the control group.The average SIRS score was increased at T2 and reached its peak at T3.The average SIRS score was significantly lower in the trial group than in the control group at T3-T6.The average SIRS score was significantly higher than the baseline in both groups at T7.Leucocyte increased significantly at T2 and reached its peak at T3.The leucocyte count and neutrophil percentage were significantly lower in the trial group than in the control group at T3-T6.Conclusion Ulinastatin can significantly reduce the concentration of plasma interleukin-8,SIRS score,count of leucocyte and percentage of neutrophil during perioperative period in patients receiving cardiac surgery with extracorporeal circulation.
出处
《实用临床医药杂志》
CAS
2012年第7期1-4,共4页
Journal of Clinical Medicine in Practice
关键词
体外循环
白细胞介素-8
全身炎症反应综合征
蛋白酶抑制剂
extracorporeal circulation
interleukin-8
systemic inflammatory response syndrome
protease inhibitors
作者简介
通信作者：李立环，E-mail：llhfw@sina．com
