CAJ | 학술논문

目的评价广谱蛋白酶抑制剂乌司他丁对幼猪深低温低流量体外循环(cardiopulmonary bypass,CPB)心脏手术脑损伤的影响.方法普通幼猪15只,采用随机数字表法分为3组(每组5只):乌司他丁组(U组)、对照组(C组)和假手术组(S组).U组和C组麻醉后正中开胸,常规建立CPB,降温至25℃后,低流量循环(50 ml·kg-1·min-1),主动脉阻断120 min后开放,调整停机后观察120 min,取海马组织.U组在CPB开始和主动脉开放即刻分别给予乌司他丁1.2万IU/kg,C组给予等量生理盐水.S组麻醉、单纯开胸,即取脑海马组织.3组在麻醉诱导后即刻(T1)、U组和C组在停机后5 min(T2)、120 min(T3)取静脉血,ELISA法测神经元特异性烯醇化酶(neuron-specific enolase,NSE)、S100蛋白β亚型(S100 protein β subtypes,S100β)、髓鞘碱性蛋白(myelinbasicprotein,MBP).光镜下观察海马病理学结果,测含水量.结果15只幼猪均完成至实验终点.与T1相比,C组在T2、T3时点NSE、S100β、MBP分别升高30.2、32.3、62.0％和33.1、29.8、57.1％,差异均有统计学意义(P＜0.05)；U组在T2、T3时点NSE、S100β、MBP分别低于相应时点C组16.8、7.3、20.4％和20.4、2.7、18.5％,差异均有统计学意义(P＜0.05).C组、U组均可见脑损伤,U组较轻.含水量C组比U组升高2.2％(P＜0.05).结论深低温低流量CPB心脏手术对幼猪存在脑损伤,乌司他丁具有对抗脑损伤(脑保护)作用.
목적 평개엄보단백매억제제오사타정대유저심저온저류량체외순배(cardiopulmonary bypass,CPB)심장수술뇌손상적영향.방법 보통유저15지,채용수궤수자표법분위3조(매조5지):오사타정조(U조)、대조조(C조)화가수술조(S조).U조화C조마취후정중개흉,상규건립CPB,강온지25℃후,저류량순배(50 ml·kg-1·min-1),주동맥조단120 min후개방,조정정궤후관찰120 min,취해마조직.U조재CPB개시화주동맥개방즉각분별급여오사타정1.2만IU/kg,C조급여등량생리염수.S조마취、단순개흉,즉취뇌해마조직.3조재마취유도후즉각(T1)、U조화C조재정궤후5 min(T2)、120 min(T3)취정맥혈,ELISA법측신경원특이성희순화매(neuron-specific enolase,NSE)、S100단백β아형(S100 protein β subtypes,S100β)、수초감성단백(myelinbasicprotein,MBP).광경하관찰해마병이학결과,측함수량.결과15지유저균완성지실험종점.여T1상비,C조재T2、T3시점NSE、S100β、MBP분별승고30.2、32.3、62.0％화33.1、29.8、57.1％,차이균유통계학의의(P＜0.05)；U조재T2、T3시점NSE、S100β、MBP분별저우상응시점C조16.8、7.3、20.4％화20.4、2.7、18.5％,차이균유통계학의의(P＜0.05).C조、U조균가견뇌손상,U조교경.함수량C조비U조승고2.2％(P＜0.05).결론 심저온저류량CPB심장수술대유저존재뇌손상,오사타정구유대항뇌손상(뇌보호)작용.
Objective To evaluate the effect of ulinastatin on brain injury caused by deep hypothermic low-flow cardiopulmonary bypass (CPB) cardiac surgery in piglets. Methods 15 general-type piglets were assigned into ulinastatin group (group U,n=5),control group (group C,n=5) and sham operation group (group S,n=5),randomly.Routine CPB was established after median thoracotomy in group U and C under anesthesia.When the temperature of piglets dropped to 25 ℃,low-flow CPB (50 ml·kg-1· min-1)began.After 120min of aortic cross-clamping,the aortic was declamped and finally weaned from CPB and piglets were sacrificed and brain hippocampus tissue was harvested following 120 min observation after CPB ceasation,12 000 IU/kg of ulinastatin was given instantly when CPB began and aortic declamp in group U respectively,and group C received equivale saline.Brain hippocampus tissue was harvested after anesthesia and median thoracotomy in group S.Venous blood samples were taken immediately after anesthesia induction (T1) in all groups,5 min(T2) and 120 min(T3) after the CPB shutdown in both Group U and C,for the test of neuron-specific enolase (NSE),S100 protein β subtypes (S100β) and myelinbasicprotein (MBP) by ELISA method.Pathology results of hippocampus were observed by light microscopy,and their water content were also measured. Results All 15 piglets completed experiment end.In group C,compared with T1 timepoint,NSE,S100β,MBP were significantly increased by 30.2,32.3,62.0％ in T2 and 33.1,29.8,57.1％ in T3 timepoints respectively (P＜0.05).Compared with group C,NSE,S100β,MBP were significantly decreased by 16.8,7.3,20.4％ in T2 and 20.4,2.7,18.5 ％,in T3 timepoints respectively in group U (P＜0.05).Brain injury was observed in both group U and C,and was lighter in group U.Water content of hippocampus was increased by 2.2％ in group C than that of group U (P＜0.05). Conclusions Deep hypothermic low-flow cardiopulmonary bypass surgery would result in brain injury on piglets,and ulinastatin could inhibit against those injury.