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目的探讨乌司他丁和甲基泼尼松龙在婴幼儿体外循环心脏手术中脑损伤的保护作用。方法 90例先天性心脏病行体外循环心脏手术的婴幼儿分为乌司他丁组30例、甲基泼尼松龙组30例和手术对照组30例,其中乌司他丁组患儿给予10 000u/kg乌司他丁静脉注射,复温后和停机后分别再次给予5 000u/kg乌司他丁;甲基泼尼松龙组患儿在预充液中加入甲基泼尼松龙30mg/kg;手术对照组患儿加入等量生理盐水;选择30例健康婴幼儿作为健康对照组。采用ELISA法检测健康对照组及其他3组患儿手术前(T_0)、体外循环开始30min(T_1)、停体外循环即刻(T_2)、停体外循环6h(T_3)、停体外循环12h(T_4)、停体外循环24h(T_5)、停体外循环48h(T_6)时血清星形胶质细胞S-100β蛋白(astroglial cell S-100βprotein,S-100β)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)和IL-8水平。结果手术对照组T1~T4时血清S-100β水平[(0.71±0.22)、(0.91±0.27)、(0.77±0.21)、(0.72±0.18)μg/L]高于乌司他丁组[(0.48±0.04)、(0.59±0.14)、(0.51±0.05)、(0.45±0.03)μg/L]、甲基泼尼松龙组[(0.50±0.10)、(0.61±0.16)、(0.50±0.12)、(0.43±0.11)μg/L]和健康对照组[(0.41±0.05)μg/L](P<0.05);手术对照组T1~T5时血清TNF-α水平[(177.4±22.8)、(189.7±26.5)、(182.5±24.3)、(173.2±25.5)、(163.5±18.4)ng/L]和IL-6水平[(67.43±7.46)、(70.04±8.12)、(71.12±7.77)、(67.45±8.11)、(63.24±7.75)ng/L]均高于乌司他丁组[TNF-α(147.4±18.3)、(153.5±23.6)、(146.9±14.7)、(142.8±17.3)、(136.9±15.3)ng/L,IL-6(51.76±7.45)、(58.02±7.43)、(55.34±7.86)、(51.23±7.85)、(51.54±8.04)ng/L]、甲基泼尼松龙组[TNF-α(146.5±19.7)、(152.2±26.4)、(147.8±16.6)、(143.6±18.5)、(137.6±14.8)ng/L,IL-6(51.21±8.03)、(57.78±7.69)、(56.23±8.00)、(53.42±7.76)、(51.12±7.94)ng/L]和健康对照组[TNF-α(135.1±20.4)ng/L、IL-6(43.23±7.87)ng/L](P<0.05);手术对照组T1~T5时IL-8水平[(1.11±0.10)、(1.13±0.09)、(1.12±0.11)、(0.92±0.05)、(0.74±0.04)μg/L]高于乌司他丁组[(0.67±0.09)、(0.70±0.07)、(0.72±0.09)、(0.65±0.06)、(0.51±0.07)μg/L]、甲基泼尼松龙组[(0.69±0.08)、(0.72±0.08)、(0.74±0.10)、(0.64±0.07)、(0.53±0.08)μg/L]和健康对照组[(0.41±0.04)μg/L](P<0.05);不同时间点乌司他丁组与甲基泼尼松龙组血清S-100β、TNF-α、IL-6和IL-8水平比较差异均无统计学意义(P>0.05)。结论乌司他丁和甲基泼尼松龙在婴幼儿体外循环心脏手术中具有脑保护和抑制炎症反应的作用。
Objective To investigate the protective effect of ulinastatin and methylprednisolone on brain injury during cardiopulmonary bypass in infants and young children. Methods Totally 90 infants with congenital heart disease undergoing cardiopulmonary bypass were divided into ulinastatin group (n = 30), methylprednisolone group (n = 30) and operation control group (n = 30) 10 000u / kg ulinastatin intravenous injection, after rewarming and downtime were given 5 000u / kg ulinastatin; methyl prednisolone group of children in the pre-filled with methylprednisolone 30mg / kg; surgery control group of children with the same amount of saline; select 30 healthy infants as a healthy control group. The levels of T_0, T_1, T_2, T_3 and T_4 of the healthy control group and the other three groups were detected by ELISA. , Astroglial cell S-100βprotein (S-100β) and tumor necrosis factor-α (TNF-α) were detected after 24h of cardiopulmonary bypass (T_5) , TNF-α), interleukin-6 (IL-6) and IL-8 levels. Results The levels of serum S-100β in T1 ~ T4 group were significantly higher than those in ulinastatin group [(0.71 ± 0.22), (0.91 ± 0.27), (0.77 ± 0.21), (0.72 ± 0.18) μg / L] 0.48 ± 0.04), (0.59 ± 0.14), (0.51 ± 0.05) and (0.45 ± 0.03) μg / L, respectively (0.43 ± 0.11) μg / L] and healthy control group (0.41 ± 0.05) μg / L] (P <0.05). The level of serum TNF-α at T1 ~ T5 in the surgical control group [(177.4 ± 22.8) , (189.7 ± 26.5), (182.5 ± 24.3), (173.2 ± 25.5) and (163.5 ± 18.4) ng / L] and IL-6 levels [(67.43 ± 7.46), (70.04 ± 8.12) and ), (67.45 ± 8.11) and (63.24 ± 7.75) ng / L, respectively, were significantly higher in the ulinastatin group than in the ulinastatin group [147.4 ± 18.3, 153.5 ± 23.6, 146.9 ± 14.7, 17.3), (136.9 ± 15.3) ng / L, IL-6 (51.76 ± 7.45), (58.02 ± 7.43), (55.34 ± 7.86), (51.23 ± 7.85), (51.54 ± 8.04) ng / L] The levels of TNF-α (146.5 ± 19.7, 152.2 ± 26.4, 147.8 ± 16.6, 143.6 ± 18.5, 137.6 ± 14.8 ng / L, 51.21 ± 8.03 (57.78 ± 7.69), (56.23 ± 8.00), (53.42 ± 7.76), (51.12 ± 7.94) ng / L, respectively) and the levels of TNF-α 4 (1.11 ± 0.10), (1.13 ± 0.09), (1.12 ± 0.11), (0.92 ± 0.05), (3.23 ± 7.87) ng / L] (0.74 ± 0.04) μg / L] were higher than those in the ulinastatin group [(0.67 ± 0.09), (0.70 ± 0.07), (0.72 ± 0.09), (0.65 ± 0.06), (0.51 ± 0.07) μg / (0.69 ± 0.08), (0.72 ± 0.08), (0.74 ± 0.10), (0.64 ± 0.07) and (0.53 ± 0.08) μg / L respectively in the methylprednisolone group and [ 0.04) μg / L] (P <0.05). There was no statistical difference in the serum levels of S-100β, TNF-α, IL-6 and IL-8 between ulinastatin group and methylprednisolone group at different time points Significance (P> 0.05). Conclusion Ulinastatin and methylprednisolone can protect the brain and inhibit the inflammatory reaction during cardiopulmonary bypass.