CAJ | 학술논문

目的观察体外循环(CPB)心脏手术患者中性粒细胞(PMN)凋亡、呼吸爆发的变化及乌司他丁对其影响.方法选择在CPB下行瓣膜置换术患者62例,随机分成乌司他丁组(U组)和对照组(C组),每组各31例.U组患者于麻醉诱导后给予乌司他丁,C组患者则给予等容积的0.9%NaCI溶液.分别于麻醉后手术前(T1)、CPB开始后30 min(T2)、CPB停止后30 min(T3)抽取动脉血,分离PMN,检测PMN凋亡率,呼吸爆发以及血浆中超氧化物歧化酶(SOD)和丙二醛(MDA)的水平.结果 C组PMN凋亡率在T1为(66.57±5.93)%,T2为(55.37±3.51)%,T3为(48.92±4.21)%,T2、T3均较T1显著降低(P<0.05),并于T3达最低值;U组PMN凋亡率在T1为(73.57±7.94)%,T2为(68.34±4.92)%,T3为(62.13±4.76)%,T2、T3均较T1显著降低(P<0.05),并于T3达最低值;C组PMN凋亡率显著低于U组(P<0.05).两组PMN呼吸爆发均表现为CPB开始后逐渐升高,T3达到峰值;U组T2(1105.94±84.15)MCF,T3(1156.52±93.20)MCF,与C组T2(1266.06±99.55)MCF,T3(1422.50±89.75)MCF比较明显降低(P<0.05).两组SOD均于手术开始后逐渐下降(P<0.05),C组T3SOD为(47.39±6.07)μU/L显著低于U组的(51.35±6.22)μU/L(P<0.05).两组MDA均于手术开始后逐渐升高(P<0.05),T3达高峰,C组为(13.72±1.15)μmol/L,U组为(8.40±0.88)μmoI/L,C组显著高于U组(P<0.05).结论 CPB引起PMN凋亡率降低、凋亡延迟,呼吸爆发增强,乌司他丁能有效地促进过度激活的PMN凋亡、抑制PMN呼吸爆发,提高SOD,降低MDA,减轻CPB对机体的炎性反应及氧化损伤,对机体具有保护作用.
목적 관찰체외순배(CPB)심장수술환자중성립세포(PMN)조망、호흡폭발적변화급오사타정대기영향.방법 선택재CPB하행판막치환술환자62례,수궤분성오사타정조(U조)화대조조(C조),매조각31례.U조환자우마취유도후급여오사타정,C조환자칙급여등용적적0.9%NaCI용액.분별우마취후수술전(T1)、CPB개시후30 min(T2)、CPB정지후30 min(T3)추취동맥혈,분리PMN,검측PMN조망솔,호흡폭발이급혈장중초양화물기화매(SOD)화병이철(MDA)적수평.결과 C조PMN조망솔재T1위(66.57±5.93)%,T2위(55.37±3.51)%,T3위(48.92±4.21)%,T2、T3균교T1현저강저(P<0.05),병우T3체최저치;U조PMN조망솔재T1위(73.57±7.94)%,T2위(68.34±4.92)%,T3위(62.13±4.76)%,T2、T3균교T1현저강저(P<0.05),병우T3체최저치;C조PMN조망솔현저저우U조(P<0.05).량조PMN호흡폭발균표현위CPB개시후축점승고,T3체도봉치;U조T2(1105.94±84.15)MCF,T3(1156.52±93.20)MCF,여C조T2(1266.06±99.55)MCF,T3(1422.50±89.75)MCF비교명현강저(P<0.05).량조SOD균우수술개시후축점하강(P<0.05),C조T3SOD위(47.39±6.07)μU/L현저저우U조적(51.35±6.22)μU/L(P<0.05).량조MDA균우수술개시후축점승고(P<0.05),T3체고봉,C조위(13.72±1.15)μmol/L,U조위(8.40±0.88)μmoI/L,C조현저고우U조(P<0.05).결론 CPB인기PMN조망솔강저、조망연지,호흡폭발증강,오사타정능유효지촉진과도격활적PMN조망、억제PMN호흡폭발,제고SOD,강저MDA,감경CPB대궤체적염성반응급양화손상,대궤체구유보호작용.
Objective To investigate the change of the neutrophil apoptosis and neutrophil respiratory burst in the patients and the effect of ulinastatin on the apoptosis of neutrophil and respiratory burst of neutrophil during cardiopulmonary bypass (CPB). Methods Sixty-two patients undergoing valve replacement with CPB were randomly divided into two groups: ulinastatin group (U group, 31 cases) and control group (C group, 31 cases). In U group patients received ulinastatin after induction of anesthesia. In C group patients received equal volume of normal saline, instead of ulinastatin. Arterial blood was obtained before operation (T1), 30 min after the start of CPB (T2), 30 min after the termination of CPB (T3). The apoptosis of neutrophil and respiratory burst of neutrophil were measured by flow cytometer. The level of superoxide dismutase (SOD) and malondialdehyde (MDA) were measured by kit. Results In C group, compared with T1 [(66.57±5.93)%], the rate of the apoptosis of neutrophil was significantly decreased at T2[(55.37±3.51)%] and T3 [(48.92±4.21)%] (P<0.05). And in U group, compared with T1 [(73.57±7.94)%], the rate of the apoptosis of neutrophil was significantly decreased at T2 [(68.34±4.92)% ] and T3 [(62.13±4.76)%] (P<0.05), And it reached to the minimum at T3. The rate of the neutrephil apeptosis was significantly lower in C group than that in U group (P<0.05). The respiratory burst of neutrophil increased significantly after the start of CPB and reached to the peak at T3[C group (1422.50±89.75) MCF,U group (1156.52±93.20) MCF]. The respiratory burst of neutrophil in U group was significandy lower than that in C group at T2 and T3 (P<0.05). The vitality of SOD decreased significantly after the start of operation in the two groups (P<0.05). The level of MDA increased significantly after the start of operation in the two groups, and reached to the peak at T3. The vitality of SOD in C group was significantly lower than that in U group at T3 (P<0.05). The level of MDA in C group was significantly higher than that in U group at T3 (P<0.05). Conclusions The rate of neutrophil apoptosis decreased and the respiratory burst of neutrophil increased during CPB. By improving the apoptosis of neutrophil and reducing the respiratory burst of neutrophil, ulinastatin can inhibit inflammatory reaction during CPB. Meanwhile, ulinastatin can improve the vitality of SOD and reduce the level of MDA. In conclusion, ulinastatin has a significant protective effect during CPB.