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乌司他丁对瓣膜置换术患者粘附分子的影响 被引量：2

Effects of Ulinastation on Adhesion Molecules in Patients with Rheumatic Heart Disease Unndergoing Mitral Valve Replacement
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摘要 目的　探讨尿胰蛋白酶抑制剂乌司他丁 (Ulinastatin)对风湿性心脏病二尖瓣置换术患者粘附分子的影响。方法　 2 0例择期行二尖瓣置换手术的风心病患者随机分为两组 (每组 10例 ) ,乌司他丁组应用 12 0 0 0U/kg于麻醉诱导后静脉推注 ,对照组不加乌司他丁。分别在麻醉诱导后、CPB30min、手术结束时、术后第一天和第二天抽取血标本 ,用流式细胞仪测定中性粒细胞CD11b、CD18和CD11b/CD18阳性细胞百分率 ,用ELISA法测定血清中的内皮细胞表达的细胞间粘附分子 - 1(ICAM - 1)。结果　CPB30min直至术后第二天 ,对照组中性粒细胞CD11b、CD18和CD11b/CD18阳性细胞百分率均较乌司他丁组明显升高 (p <0 .0 5 ) ;术后第一天及术后第二天 ,对照组血清ICAM - 1含量较乌司他丁组明显增加 (p <0 .0 5 )。结论　乌司他丁能明显抑制风心病二尖瓣置换术患者中性粒细胞表面CD11b、CD18、CD11b/CD18以及血清ICAM - 1的表达 。 OBJECTIVE To explore the effects of ulinastatin on adhesion molecules in patients with rheumatic heart disease undergoing valve replacement. METHODS Twenty patients scheduled for elective mitral valve replacement were randomized into two groups: (1) control (n=10), or (2) venous injection of ulinastatin (12 000U/kg) after anesthesia induction (n=10). Blood samples were drawn from radial artery at baseline, 30 minutes of CPB, end of operation, 1 day after operation and 2 day after operation. Neutrophil CD11b, CD18 and CD11b/CD18 were measured by FCM. ICAM-1 in blood serum was measured by ELISA. RESULTS The institution of CPB in the patients undergoing mitral valve replacement induced up-regulation of the neutrophil CD11b, CD18, CD11b/CD18 and serum ICAM-1. There was no significante difference in baseline value. Samples from the control group demonstrated significant increases (p<0.05) in CD11b, CD18 and CD11b/CD18 positive cell percentage when compared to unlinastatin group at the same time intervals. CONCLUSION These results indicate that ulinastatin modulates the CPB-induced up-regulation of neutrophil CD11b, CD18, CD11b/CD18 and serum ICAM-1, the important indicator of the systemic inflammatory response to CPB. Therefore, these data indicate that ulinastatin is effective in reducing this inflammatory response, attenuating heart and lung reperfusion injury, protecting the function of important organs in the patients undergoing mitral valve replacement.
作者 张凤伟 吴树明 邢西忠 孙培玉 张秀辉
机构地区 山东大学齐鲁医院心脏外科 临沂市人民医院
出处 《中国体外循环杂志》 2003年第3期145-148,共4页 Chinese Journal of Extracorporeal Circulation
关键词 乌司他丁 瓣膜置换术 粘附分子 尿胰蛋白酶抑制剂 风湿性心脏病 Ulinastatin adhesion molecule mitral valve replacement cardiopulmonary bypass rheumatic heart disease
分类号 R654.2 [医药卫生—外科学] R977 [医药卫生—药品]
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参考文献12

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同被引文献30

  • 1任斌辉,景华,李德闽,李忠东.乌司他丁对肺功能的保护作用[J].医学研究生学报,2004,17(6):519-521. 被引量：20
  • 2肖雅琼,肖诗亮,孙宗全,张凯伦,胡志伟.婴幼儿先天性心脏病术后并发症的临床分析[J].临床心血管病杂志,2006,22(6):366-367. 被引量：8
  • 3薛庆华,昌克勤,程卫平,凌坚,张艳婉,李立环.乌司他丁对体外循环患者肺灌洗液中炎性因子和肺功能的影响[J].中国循环杂志,2006,21(4):297-300. 被引量：12
  • 4Heindl B, Reichle FM, Zahler S, et al. Sevoflurane and isoflurane protect the reperfused guinea pig heart by reducing postischemic adhesion of polymorphonuclear neutrophils[J]. Anesthesiology, 1999,91(2) :521～530
  • 5Zilberstein G, Levy R, Rachinsly M, et al. Ketamine attenuates neutrophil activation after cardiopulmonary bypass[J ]. Anesth Analg,2002,95(3) :531 ～536
  • 6Alonso A, Whitten CW, Hill GE. Pump prime only aprotinin inhibits cardiopulmonary bypass- induced neutrophil CD1 1b up-regulation[J]. Ann Thorac Surg, 1999, 67(2): 392～395
  • 7Chello M, Mastroroberto P, Patti G, et al. Simvastatin attenuatesleucocyte-endothelial interactions after coronary revascularisation with cardiopulmonary bypass[J]. Heart, 2003,89(5) :538～543
  • 8Hayashi Y, Sawa Y, Nishimura M, et al. P-Selectin monoclonal antibody may attenuate the whole body inflammatory response induced by cardiopulmonary bypass[J]. Asaio J, 2000,46(3) :334～337
  • 9Mcbride WT, Armstrong MA, Crockard AD, et al. Cytokine balance and immunosuppressive changes at cardiac surgery: contrasting response between patients and isolated CPB circuits[J]. Br J Anaesth,1995, 75(6) :724～733
  • 10Hambsch J, Osmancik P, Bocsi J, et al. Neutrophil adhesion molecule expression and serum concentration of soluble adhesion molecules during and after pediatric cardiovascular surgery with or without cardiopulmonary bypass[J ]. Anesthesiology, 2002,96(5 ): 1 078～ 1 085

引证文献2

二级引证文献5

中国体外循环杂志
2003年 第3期

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