摘要
目的探讨氨茶碱与乌司他丁合用对体外循环(CPB)术后炎症介质的影响。方法选取体重≤7 kg的单纯室间隔缺损新生儿及低体重婴幼儿60例,随机分为氨茶碱组(A组)、乌司他丁组(U组)、联合组(AU组)和对照组(C组),每组15例。A组麻醉诱导后静脉注射氨茶碱5mg/kg,并在CPB过程中按0.5 mg/kg/h维持;U组在CPB过程中按10000 U/kg应用乌司他丁;AU组联合应用上述两种药物;C组未给予氨茶碱及乌司他丁。选取CPB启动前(t_1)、结束时(t_2)、CPB后1 h(t_3)、CPB后6 h(t_4)、CPB后24 h(t_5)5个时间点,检测血浆肿瘤坏死因子α(TNF-α)、白细胞介素6 (IL-6)、白细胞介素8(IL-8)和白细胞介素10(IL-10)以及CPB后1 h支气管肺泡灌洗液(BALF)中TNF-α、IL-6水平。结果血浆TNF-α、IL-6、IL-8和IL-10在t_2开始升高,t_3达峰值;BALF中TNF-α、IL-6水平高于血浆水平。与C组相比,A组、U组、AU组CPB结束后各时间点血浆TNF-α、IL-6、IL-8、IL-10及BALF中TNF-α、IL-6水平明显降低(P<0.05),AU组效果更明显。结论氨茶碱和乌司他丁可抑制体外循环心内直视手术患儿围术期促炎细胞因子的释放,并上调抗炎细胞因子,减轻体外循环引起的急性炎症反应,两者联合应用有协同作用。
Cbjective To study the combined effects ofamphylline and ulinastatin to inflammatory cytokines in infants who underwent cardiac operation under cardiopulmonary bypass （CPB）. Methods 60 neonates or infants who weight less than 7 kilograms and suffering with single ventricular septal defect were divided randomly into 4 groups： the Arnphylline group, the Uinastatin group, the Combo group and the Control group （15 cases for each group）. Patients in the Amphylline group were treated with intravenous injection of amphyltine （5mg/kg） after the anesthesia induction, and then continued （0.5mg/kg/h） during the total CPB. Patients in the Uinastatin group were treated with ulinastatin at a dosage of 10000U/kg during the CPB. Patients in the Combo group were treated with both amphylline and ulinastatin at the same manner mentioned above. Patients in the Control group were not treated with anaphylline or ulinastatin. Plasma tumor necrosis factor-α （TNF-α）, interleukin-6 （IL-6）, interleukin-8 （IL-8） and interleukin-10 （IL-10） were measured at different time points （before the CPB, the end of CPB, 1 hour after the CPB, 6 hours after the CPB and 24 hours after the CPB） and the concentration of TIW-α and IL-6 in bronchoalveolar fluid （BALF） were measured 1 hour after the CPB. Results The plasma concentration of TNF-α, IL-6, IL-8 and IL-10 began to increase after the CPB and reach to the top level at 1 hour after the CPB. And the concentration of TNF-α and IL-6 in BALF was higher than that in the plasma. Compared with the Control group, patients in the Arnphylline, the Ulinastatin and the Combo group had a lower concentration of plasma TNF-α, IL-6, IL-8 and IL-10 and a lower concentration OfBALF TNF-α IL-6 after CPB （all time points, P〈0.05）. The effects were more manifest in the Combo group. Conclusions Both amphylline and ulinastatin can effectively inhibit the release of the inflammatory cytokines and promote the generation of anti-inflammatory cytokines in infants undergoing cardiac operation under CPB. When combined used, there are synergistic effect.
出处
《临床小儿外科杂志》
CAS
2007年第6期19-22,共4页
Journal of Clinical Pediatric Surgery
