乌司他丁对心脏双瓣膜置换术患者血清S—100β蛋白、神经元特异性烯醇化酶水平的影响及脑保护机制(1)
[摘要] 目的 探讨乌司他丁对心脏双瓣膜置换术患者血清S-100β蛋白、神经元特异性烯醇化酶(NSE)水平的影响及作用机制。 方法 将2009年9月～2014年9月在张家口市第一医院行心脏双瓣膜置换术的40例患者按照随机数字表法分为试验组20例和对照组20例。两组患者麻醉诱导、麻醉维持及手术方法相同，其中试验组于麻醉诱导后给予乌司他丁，对照组给予等量生理盐水。比较两组升主动脉阻断时间、体外循环(CPB)时间、机械通气时间、术后拔管时间、术后清醒时间及手术前后认知功能情况；分别于中心静脉通路建立后(T0)、CPB开始30 min(T1)、CPB结束时(T2)、手术结束时(T3)、术后6 h(T4)抽取静脉血5 mL，采用酶联免疫吸附测定(ELISA)检测两组患者各时段血清S-100β蛋白、NSE水平；分别于术前1 d、术后1、3、5 d采用精神状态检查量表(MMSE)对两组患者认知功能进行评价。 结果 两组患者升主动脉阻断时间、CPB时间、机械通气时间、术后拔管时间、术后清醒时间比较差异无统计学意义(P > 0.05)，术后1、3、5 d试验组MMSE评分显著高于对照组，差异有统计学意义(P < 0.05)。两组患者血清S-100β、NSE水平从T1开始升高，至T2时达到高峰，随后逐渐降低，至T4时降低至T0水平；其中试验组T1、T2、T3时血清S-100β、NSE水平显著低于对照组，差异有统计学意义(P < 0.05)。 结论 乌司他丁能够改善心脏双瓣膜置换术后患者的脑损伤，其作用机制可能与降低CPB中诱导的炎性反应、减轻炎性反应介导的脑组织损伤有关。
[关键词] 乌司他丁；心脏双瓣膜置换术；神经元特异性烯醇化酶；S-100β蛋白；作用机制
[中图分类号] R969.4 [文献标识码] A [文章编号] 1673-7210(2015)07(c)-0106-05
[Abstract] Objective To explore the effect and mechanism of Ulinastatin on serum S-100β protein， neuron-specific enolase (NSE) levels of patients with double cardiac valve replacement. Methods A total of 40 cases of patients taken double cardiac valve replacement in the First Hospital of Zhangjiakou City from September 2009 to September 2014 were divided into 20 cases of experimental group and 20 cases of control group according to random number table. Both groups were taken the same anesthesia induction， anesthesia maintenance and surgery method， of which， the experimental group was given Ulinastatin after anesthesia induction， the control group was given equivalent normal saline. The ascending aortic clamping time， cardiopulmonary bypass (CPB) time， mechanical ventilation time， extubation time， postoperative awake time and cognitive function before and after operation between the two groups were compared， and 5 mL venous blood was extracted at the time points of after the establishment of central venous access (T0)， 30 min before CPB (T1)， the end of CPB (T2)， the end of surgery (T3)， postoperative 6 h (T4)， the levels of serum S-100β， NSE at different time points were detected by enzyme-linked immunosorbent assay (ELISA) method. The cognitive function of the two groups was evaluated by mini-mental state examination (MMSE) at preoperative 1 d， postoperative 1， 3， 5 d. Results The ascending aortic clamping time， CPB time， mechanical ventilation time， extubation time， postoperative awake time of the two groups had no statistically significant differences (P > 0.05)， the MMSE scores in postoperative 1， 3， 5 d of the experimental group were significantly higher than those of control group， the differences between the two groups were statistically significant (P < 0.05). The levels of serum S-100β， NSE of the two groups began to increase from T1， and reached the peak at T2， then gradually decreased， when it reached to T4， it decreased to T0 level； wherein the levels of serum S-100β， NSE at T1， T2， T3 in experimental group were significantly lower than those of control group (P < 0.05). Conclusion Ulinastatin can improve the cerebral injury of patients with double cardiac valve replacement， the mechanism may be related to reducing the inflammatory reaction induced by CPB， relieving brain injury mediated by inflammatory reaction. (郭云惠等)
[关键词] 乌司他丁；心脏双瓣膜置换术；神经元特异性烯醇化酶；S-100β蛋白；作用机制
[中图分类号] R969.4 [文献标识码] A [文章编号] 1673-7210(2015)07(c)-0106-05
[Abstract] Objective To explore the effect and mechanism of Ulinastatin on serum S-100β protein， neuron-specific enolase (NSE) levels of patients with double cardiac valve replacement. Methods A total of 40 cases of patients taken double cardiac valve replacement in the First Hospital of Zhangjiakou City from September 2009 to September 2014 were divided into 20 cases of experimental group and 20 cases of control group according to random number table. Both groups were taken the same anesthesia induction， anesthesia maintenance and surgery method， of which， the experimental group was given Ulinastatin after anesthesia induction， the control group was given equivalent normal saline. The ascending aortic clamping time， cardiopulmonary bypass (CPB) time， mechanical ventilation time， extubation time， postoperative awake time and cognitive function before and after operation between the two groups were compared， and 5 mL venous blood was extracted at the time points of after the establishment of central venous access (T0)， 30 min before CPB (T1)， the end of CPB (T2)， the end of surgery (T3)， postoperative 6 h (T4)， the levels of serum S-100β， NSE at different time points were detected by enzyme-linked immunosorbent assay (ELISA) method. The cognitive function of the two groups was evaluated by mini-mental state examination (MMSE) at preoperative 1 d， postoperative 1， 3， 5 d. Results The ascending aortic clamping time， CPB time， mechanical ventilation time， extubation time， postoperative awake time of the two groups had no statistically significant differences (P > 0.05)， the MMSE scores in postoperative 1， 3， 5 d of the experimental group were significantly higher than those of control group， the differences between the two groups were statistically significant (P < 0.05). The levels of serum S-100β， NSE of the two groups began to increase from T1， and reached the peak at T2， then gradually decreased， when it reached to T4， it decreased to T0 level； wherein the levels of serum S-100β， NSE at T1， T2， T3 in experimental group were significantly lower than those of control group (P < 0.05). Conclusion Ulinastatin can improve the cerebral injury of patients with double cardiac valve replacement， the mechanism may be related to reducing the inflammatory reaction induced by CPB， relieving brain injury mediated by inflammatory reaction. (郭云惠等)