CAJ | 학술논문

目的了解氨力农及抑肽酶对瓣膜置换术患者围手术期全身炎症应答的影响。方法将接受瓣膜置换手术的24例患者随机分为对照组（A组，n=8）、抑肽酶组（B组，n=8）和氨力农加抑肽酶组 (C组，n=8)。A组患者不使用抑肽酶；B组患者于预充液中加入抑肽酶300万单位；C组患者开胸前按1mg/kg静脉注射氨力农，然后以8μg/(kg*min)静脉泵入直到停机，并在转流前将抑肽酶300万单位加入预充液。分别于术前、停机、停机后1小时及术后1天抽取患者外周血，用IL-6 和 IL-8 ELISA试剂盒双抗体夹心ELISA法测定IL-6 和 IL-8 。结果体外循环术前，三组患者血浆中的IL-6和IL-8水平无明显差异（P>0.05）。体外循环术后，三组患者血浆中IL-6和IL-8水平均明显升高（P<0.05），术后1天虽仍高于术前，但差异无显著性（P>0.05）。停机后1小时的IL-6水平，B组低于A组，C组低于B组，但这种差异无统计学意义（P>0.05）。B组及C组停机后的IL-8水平也低于A组同期水平，C组在此时间点和停机后1小时亦低于B组和 A组，但这些差异亦无统计学意义（P>0.05）。结论尽管氨力农和抑肽酶均有抗炎症的效应，但是仅在预充液中加入抑肽酶或在此基础上联合应用氨力农，均难以完全抑制瓣膜置换手术患者围术期促炎性细胞因子IL-6 和IL-8的释放。
목적료해안력농급억태매대판막치환술환자위수술기전신염증응답적영향。방법장접수판막치환수술적24례환자수궤분위대조조（A조，n=8）、억태매조（B조，n=8）화안력농가억태매조 (C조，n=8)。A조환자불사용억태매；B조환자우예충액중가입억태매300만단위；C조환자개흉전안1mg/kg정맥주사안력농，연후이8μg/(kg*min)정맥빙입직도정궤，병재전류전장억태매300만단위가입예충액。분별우술전、정궤、정궤후1소시급술후1천추취환자외주혈，용IL-6 화 IL-8 ELISA시제합쌍항체협심ELISA법측정IL-6 화 IL-8 。결과체외순배술전，삼조환자혈장중적IL-6화IL-8수평무명현차이（P>0.05）。체외순배술후，삼조환자혈장중IL-6화IL-8수평균명현승고（P<0.05），술후1천수잉고우술전，단차이무현저성（P>0.05）。정궤후1소시적IL-6수평，B조저우A조，C조저우B조，단저충차이무통계학의의（P>0.05）。B조급C조정궤후적IL-8수평야저우A조동기수평，C조재차시간점화정궤후1소시역저우B조화 A조，단저사차이역무통계학의의（P>0.05）。결론진관안력농화억태매균유항염증적효응，단시부재예충액중가입억태매혹재차기출상연합응용안력농，균난이완전억제판막치환수술환자위술기촉염성세포인자IL-6 화IL-8적석방。
Objective　To explore the effect of amrinone and aprotinin on whole-body inflammatory response in the patients with prosthetic valve replacement during perioperative period. Methods　24 patients undergoing prosthetic valve replacment were randomized to control group (group A, n=8) , aprotinin group (group B, n=8) and amrinone combined with aprotinin group (group C, n=8). In the aprotinin group, 3×106 of aprotinin was added to the priming solution of the extracorporeal circulation (ECC). In the amrinone combined with aprotinin group 3×106 of aprotinin was added to the priming solution of the ECC and amrinone began with a bolus of 1mg/kg followed by a maintenance infusion of 8μg/(kg*min). The control group received an equivalent prime volume without aprotinin. Venous blood samples were drawn before the operation, at the end of ECC, 1 hour after the end of ECC, and one day after the operation respectively. Enzyme-linked immunosorbent assay techniques were used to measure each of the cytokines. Results　Before ECC, there were no differences of the levels of IL-6 and IL-8 among groups (P>0.05). After ECC, the levels of IL-6 and IL-8 increased significantly in all groups (P<0.05). The levels on day one after the operation were still higher than those before the operation in all groups (except the level of IL-8 in group C), but no statistical significance was observed. (P>0.05). At 1 hour after the end of ECC, the level of IL-6 in group B was lower than that in group A, and the level of IL-6 in group C was lower than that in group B, but there was no statistically significant difference (P>0.05）；At the end of ECC, the level of IL-8 in group B was lower than that in group A and the level of IL-8 in group C was lower than that in group B, but no significant difference was noted (P>0.05). It was also observed that the level of IL-8 was lower in group C than group A or B at 1 hour after the end of ECC. Conclusion　Although amrinone and aprotinin have antiinflammatory activity, but pump prime only aprotinin or aprotinin combined with amrinone may fail in preventing proinflammatory cytokine release (IL-6, IL-8) completely in patients with prosthetic valve replacement during ECC perioperative period.