乌司他丁联合泮托拉唑对体外循环心脏手术患者炎症因子和胃肠道的影响

摘要

目的 探讨乌司他丁联合泮托拉唑对体外循环(CPB)心脏手术患者炎性因子和胃肠道的影响.方法 将200例拟施CPB下行心脏瓣膜置换手术的风湿性心脏病患者随机分为对照组(CON)、乌司他丁组(UTI)、泮托拉唑组(PTZ)和乌司他丁+泮托拉唑组(UTI+ PTZ)各50例.建立CBP前15 min,UTI组给予乌司他丁10 000 U·kg-1,PTZ组给予泮托拉唑40 mg,UTI+PTZ组给予乌司他丁10 000 U·kg-1和泮托拉唑40 mg,CON组给予等量0.9%氯化钠溶液. 4组均于术前(t1)、CPB30 min(t2)、CBP结束后(t3)、术后6 h(t4)、术后24 h(t5)测定胃黏膜pH值(pHi),采集血液标本,酶联免疫吸附测定法(ELISA)测定血浆白细胞介素-6(IL-6)和肿瘤坏死因子α(TNF-α)浓度,并于术后第1,2天随访患者是否有腹痛、腹胀、呕血、黑便和大便隐血实验阳性等消化道相关并发症.结果 与本组t1时比较,4组TNF-α、IL-6浓度在t2、t3、t4、t5均明显增高(P<0.05);与CON组比较,UTI、PTZ和UTI+PTZ组t2、t3、t4、t5时TNF-α、IL-6浓度明显降低(P<0.05);UTI和UTI+PTZ组TNF-α、IL-6浓度较PTZ组更接近正常生理值. 4组pHi值t2、t3、t4与本组t1时比较均明显降低(P<0.05), CON组t5较本组t1时明显降低(P<0.05);与CON组比较,UTI、PTZ和UTI+PTZ组t2、t3、t4时pHi值明显升高(P<0.05);UTI+PTZ组pHi值好于UTI和PTZ组. CON组术后消化道并发症较UTI、PTZ和UTI+PTZ组明显增多(P<0.05).结论乌司他丁联合泮托拉唑用于CPB心脏手术患者,能显著减轻TNF-α和IL-6释放,升高pHi,减少消化道并发症.%Objective To investigate the effect of ulinastatin combined pantoprazole on inflammatory factors and gastrointestinal tract in patients undergoing cardiopulmonary bypass ( CBP) cardiac surgery. Methods A total of 200 patients who suffered rheumatic heart disease were scheduled for valve replacement surgery with CPB, were randomly divided into four groups:control group (CON),ulinastatin (UTI),pantoprazole groups (PTZ) and ulinastatin+pantoprazole groups(UTI+PTZ),50 cases in each group.Before CBP,group UTI was given ulinastatin 10 000 U·kg-1,group PTZ was given pantoprazole 40 mg,group UTI+PTZ was given ulinastatin 10 000 U·kg-1and pantoprazole 40 mg,group CON was given 0.9% sodium chloride soution.The gastric mucosa pHi and blood samples would be collected in all four groups at the preoperative (t1),CPB 30 min (t2),after CBP (t3),6 h after surgery (t4),24 h (t5) five time points.The IL-6 and TNF-α would be detected by enzyme linked immunosorbent (ELISA) method,and abdominal distension,abdominal pain,hematemesis,black and defecate occult blood test positive for digestive tract related complications would be collected after the surgery 1,2 days. Results The concentration of TNF-α and IL-6 at t2,t3, t4,t5were higher than those at t1in all four groups(P<0.05).Compared with CON group,the concentration of TNF-α and IL-6 at t2, t3,t4,t5in UTI,PTZ and UTI+PTZ group were significantly decreased (P<0.05).The concentration of TNF-α and IL-6 in UTI and UTI+PTZ group were better than in PTZ group.The pHi at t2,t3,t4was lower than that at t1in four groups(P<0.05),and pHi at t5 was obviously lower than that at t1in group CON (P<0.05).The pHi at t2,t3,t4in UTI,PTZ and UTI+PTZ group was higher than that in CON group ( P<0. 05), and pHi in UTI+PTZ group was better than that in UTI and PTZ group. The postoperative gastrointestinal complications in CON group were higher than those in UTI,PTZ and UTI+PTZ group (P<0.05). Conclusion Ulinastatin combined with pantoprazole for patients undergoing CPB heart surgery,can significantly reduce the release of TNF-α and IL-6、increase gastric pHi and reduce the incidence of gastrointestinal complications.