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目的探讨乌司他丁对幕上肿瘤切除术患者血清肿瘤坏死因子(TNF)-α、基质金属蛋白酶(MMP)-9和基质金属蛋白酶组织抑制剂(TIMP)-1的影响。方法择期行幕上肿瘤切除术的患者纳入本研究,随机分为对照组(C组)和乌司他丁组(U组)。U组在手术开始前30 min内静脉输注乌司他丁6 000 U/kg,C组则静脉输注等容量生理盐水。分别于麻醉诱导前10 min(T0)、剪硬膜即刻(T_1)、术毕(T_2)、术后24 h(T_3)和术后72 h(T_4)检测血清TNF-α、MMP-9和TIMP-1浓度。记录术后第1、3天头痛、恶心及呕吐评分,患者ICU停留时间和术后住院时间。结果 50例患者纳入本研究,每组25例。与_T0比较,C组T_2、T_3时点血清TNF-α浓度明显升高(P<0.05)。2组T1时点血清MMP-9浓度均较T0明显升高,U组T3时点血清MMP-9浓度明显降低,2组T1~T4血清TIMP-1浓度均明显升高(P均<0.05)。与C组比较,U组T2、T3时点血清TNF-α浓度及T3时点血清MMP-9浓度明显降低(P均<0.05),T_1、T_3时点血清TIMP-1浓度明显升高(P<0.05)。与C组比较,U组患者术后第1天呕吐评分降低(P<0.05)。结论乌司他丁能够降低神经外科患者术后血清TNF-α浓度,降低术后MMP-9水平,可能具有一定的神经保护作用。
Objective To investigate the effect of ulinastatin on tumor necrosis factor-α (TNF-α), matrix metalloproteinase (MMP) -9 and tissue inhibitor of metalloproteinase-1 (TIMP-1) in patients undergoing supratentorial resection. Methods Patients undergoing elective oncological resection were enrolled in this study and were randomly divided into control group (group C) and ulinastatin group (group U). Group U received intravenous infusion of ulinastatin 6 000 U / kg within 30 min before surgery, and group C received intravenous infusion of equal volume of normal saline. Serum levels of TNF-α, MMP-9 and TNF-α were detected at 10 min (T0), immediately after sciatic nerve (T_1), at the end of operation (T_2), at 24 h after operation (T_3) and at 72 h TIMP-1 concentration. The headache, nausea and vomiting scores, the ICU stay time and the postoperative hospital stay were recorded on the 1st and 3rd postoperative days. Results 50 patients were included in this study, 25 cases in each group. Compared with _T0, the concentration of TNF-α in group C at T_2 and T_3 increased significantly (P <0.05). Serum MMP-9 levels were significantly higher than T0 in both groups at T1 time point. Serum MMP-9 levels in group U at T3 were significantly lower than those at T1 (P <0.05) . Compared with group C, the level of serum TNF-α at T2 and T3 and the level of serum MMP-9 at T3 were significantly lower in U group (all P <0.05), while the levels of TIMP-1 at T_1 and T_3 were significantly increased <0.05). Compared with group C, the vomit scores of the patients in group U decreased on the first day after operation (P <0.05). Conclusion Ulinastatin can reduce the postoperative serum levels of TNF-α in neurosurgical patients and reduce the postoperative MMP-9 levels, which may have neuroprotective effects.