乌司他丁在婴儿危重先天性心脏病术后的应用

目的探讨乌司他丁对婴儿危重先天性心脏病术后炎性反应的调节作用。方法将30例≤6个月、需手术纠治的危重先天性心脏病患儿按随机数字表法分为2组：试验组和对照组,每组15例。2组患儿均行先天性心脏病纠治手术。对照组术后仅给予常规治疗。在此基础上,试验组术后1 h即给予乌司他丁5 000 U.kg-1.次-1加入5%葡萄糖注射液10 mL中静脉滴注,8 h 1次,连用3 d。比较2组患儿性别、年龄、体质量及术中CPB时间、主动脉阻断时间等。检测2组患儿术后1（T1）、6（T2）、24（T3）、48（T4）、72（T5）h血浆白细胞介素6（interleukin-6,IL-6）、白细胞介素10（interleukin-10,IL-10）、肿瘤坏死因子α（tumor necrosis factor-α,TNF-α）、心肌肌钙蛋白Ⅰ（cardiactroponinⅠ,cTnⅠ）水平。结果 2组患儿在性别、年龄、体质量及术中CPB时间、主动脉阻断时间等方面比较差异均无统计学意义（均P〉0.05）。与对照组相比,试验组术后血浆cTnⅠ、IL-6、TNF-α水平的降低更早、更明显,试验组均在T5时点明显低于对照组（P〈0.05）。而血浆IL-10水平的降低却正好相反,试验组降低更慢,在T5时点明显高于对照组（P〈0.05）。对照组术后1例死于呼吸衰竭。试验组15例、对照组14例患儿随访3个月,均无心力衰竭、呼吸衰竭等严重并发症发生。结论乌司他丁在婴儿危重先天性心脏病术后应用可促进抑炎细胞因子IL-10的产生,抑制促炎细胞因子IL-6、TNF-α的释放,减轻心肌损伤。

Postoperative Application of Ulinastatin in Infants with Critical Congenital Heart Disease

Objective To explore the regulating effect of ulinastatin on postoperative inflammatory response in infants with critical congenital heart disease.Methods Thirty infants with critical congenital heart disease（younger than or equal to 6 months） who underwent surgical repair of congenital heart disease were randomly divided into test group and control group,with 15 infants in each group.Control group was given regular postoperative treatment.On this basis,test group received intravenous infusion of ulinastatin（5 000 U·kg-1 in 10 mL of 5% glucose solution,1 infusion per 8 hours） for 3 days.The sex,age,body weight,cardiopulmonary bypass（CPB） time,and aortic cross-clamp time were compared between test group and control group.The levels of plasma interleukin-6（IL-6）,interleukin-10（IL-10）,tumor necrosis factor-α（TNF-α） and cardiac troponin Ⅰ（cTnⅠ） were measured at postoperative hour 1（T1）,6（T2）,24（T3）,48（T4） and 72（T5）.Results There were no significant differences in the sex,age,body weight,aortic cross-clamp time and CPB time between the two groups（all P0.05）.Compared with control group,the decrease in postoperative concentrations of plasma cTnⅠ,IL-6 and TNF-α was earlier and more obvious in test group,and the most significant decrease was observed at T5（P0.05）.In contrast,the decrease in plasma IL-10 levels was slower in test group,and plasma IL-10 levels in test group were obviousy higher than those in control group at T5（P0.05）.One case died due to respiratory failure after operation in control group.All 15 infants in test group and other 14 infants in control group had no serious complications such as heart failure or respiratory failure during 3 months of follow-up.Conclusion Ulinastatin can postoperatively suppress the production of inflammatory cytokine IL-10 and the release of proinflammatory cytokines IL-6 and TNF-α,and reduce myocardial injury in infants with critical congenital heart disease.