CAJ | 학술논문

目的评价乌司他丁对体外循环(CPB)下主动脉弓手术患儿脑损伤的影响.方法拟在CPB下行主动脉缩窄或主动脉弓离断合并心内畸形矫治术的患儿20例,性别不限,年龄1～ 24月,体重3～ 12 kg,ASA分级Ⅲ或Ⅳ级.采用随机数字表法,将其分为2组(n=10):对照组(C组)和乌司他丁组(U组).U组将乌司他丁2万U/kg用生理盐水稀释至l万U/ml,麻醉诱导后颈内静脉注射1/3量,CPB开始和主动脉开放前约5 min各使用1/3量；C组以等容积生理盐水替代.分别于麻醉诱导后(T1)、主动脉阻断10 min(T2)、主动脉开放10 min(T3)、CPB结束(T4)、CPB结束后6 h(T5)和CPB结束后24 h(T)时采集桡动脉血,采用ELISA法测定血浆S100B蛋白和神经元特异性烯醇化酶(NSE)浓度.结果两组T1时血浆S100B蛋白及NSE浓度差异无统计学意义(P＞0.05)；与T1时比较,两组T2～5时血浆S100B蛋白及NSE浓度升高(P＜0.05)；与C组比较,U组T2～5时血浆S100B蛋白及NSE浓度降低(P＜0.05).结论乌司他丁可减轻CPB下主动脉弓手术患儿的脑损伤.
목적 평개오사타정대체외순배(CPB)하주동맥궁수술환인뇌손상적영향.방법 의재CPB하행주동맥축착혹주동맥궁리단합병심내기형교치술적환인20례,성별불한,년령1～ 24월,체중3～ 12 kg,ASA분급Ⅲ혹Ⅳ급.채용수궤수자표법,장기분위2조(n=10):대조조(C조)화오사타정조(U조).U조장오사타정2만U/kg용생리염수희석지l만U/ml,마취유도후경내정맥주사1/3량,CPB개시화주동맥개방전약5 min각사용1/3량；C조이등용적생리염수체대.분별우마취유도후(T1)、주동맥조단10 min(T2)、주동맥개방10 min(T3)、CPB결속(T4)、CPB결속후6 h(T5)화CPB결속후24 h(T)시채집뇨동맥혈,채용ELISA법측정혈장S100B단백화신경원특이성희순화매(NSE)농도.결과 량조T1시혈장S100B단백급NSE농도차이무통계학의의(P＞0.05)；여T1시비교,량조T2～5시혈장S100B단백급NSE농도승고(P＜0.05)；여C조비교,U조T2～5시혈장S100B단백급NSE농도강저(P＜0.05).결론 오사타정가감경CPB하주동맥궁수술환인적뇌손상.
Objective To evaluate the effects of unilastatin on brain injury in children undergoing aortic arch surgery under cardiopulmonary bypass (CPB).Methods Twenty ASA physical status Ⅲ or Ⅳ children of both sexes,aged 1-24 months,weighing 3-12 kg,undergoing repair of coarctation of aorta or interrupted aortic arch complicated with intracardiac malformations under CPB,were randomly divided into 2 groups (n =10 each):control group (group C) and ulinastatin group (group U).Ulinastatin 20 000 U/kg was diluted into 10 000 U/ml with normal saline and it was then injected intravenously in 3 parts (1/3 was injected via the internal jugular vein after induction of anesthesia; 1/3 at the beginning of CPB and 1/3 at 5 min before aortic unclamping).In group C the equal volume of normal saline was given instead of ulinastatin.Blood samples were taken from the radial artery after induction of anesthesia (T1),at 10 min after aortic clamping (T2),at 10 min after aortic unclamping (T3),at the end of CPB (T4),and at 6 and 24 h after termination of CPB (T5,T6) for determination of plasma S100B protein and neuron-specific enolase (NSE) concentrations.Results There was no significant difference in plasma levels of S100B protein and NSE at T1 between the two groups (P ＞ 0.05).Plasma S100B protein and NSE levels were significantly increased at T2-5 as compared to the baseline values at T1 in both groups (P ＜ 0.05).Plasma S100B protein and NSE levels were significantly lower at T2-5 in group U than in group C (P ＜ 0.05).Conclusion Ulinastatin can attenuate brain injury in children undergoing aortic arch surgery under CPB.