国际麻醉学与复苏杂志   2012, Issue (2): 7-7
    
乌司他丁对幼猪体外循环心脏手术脑损伤影响的实验研究
王晓凑, 薛庆华, 晏馥霞, 李立环, 刘晋萍, 李守军, 胡盛寿1()
1.北京阜外心血管病医院麻醉科
Experimental study of effect of ulinastatin on brain injury caused by deep hypothermic low-flow cardiopulmonary bypass surgery in piglets
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摘要：

目的 评价广谱蛋白酶抑制剂乌司他丁对幼猪深低温低流量体外循环(CPB)心脏手术脑损伤的影响。方法 普通幼猪15例，采用随机数字表法分为乌司他丁组（U组，n=5）、对照组（C组，n=5）和假手术组（S组，n=5）。U组和C组麻醉后正中开胸，常规建立体外循环，降温至25℃后，低流量循环（50ml.kg-1.min-1），主动脉阻断120min后开放，调整停机后观察120min，取海马组织后处死。U组在CPB开始和循环开放即刻分别给予乌司他丁1.2万IU.kg-1，C组给予等量生理盐水。S组麻醉、单纯开胸，即取脑海马组织。三组在麻醉诱导后即刻（T1）、U组和C组在停机后5min（T2）、120min（T3）取静脉血，ELISA法测神经元特异性烯醇化酶（neuron-specific enolase, NSE）、S100蛋白β亚型（S100 protein β subtypes, S100β）、髓鞘碱性蛋白（myelinbasicprotein, MBP）。光镜下观察海马病理学结果，测含水量。结果 15例幼猪均完成至实验终点。与T1相比，C组在T2、T3时点NSE、S100β、MBP分别升高30.2%、32.3%、62.0%和33.1%、29.8%、57.1%，均有统计学差异（P <0.05）；U组在T2、T3时点NSE、S100β、MBP分别低于相应时点C组16.8%、7.3%、20.4%和20.4%、2.7%、18.5%，均有统计学差异（P <0.05）。C组、U组均可见脑损伤，U组较轻。含水量C组比U组升高2.2%（P <0.05）。结论 深低温低流量体外循环心脏手术对幼猪存在脑损伤，乌司他丁具有对抗脑损伤（脑保护）作用。
关键词： 体外循环；深低温低流量；心脏手术；乌司他丁；脑损伤；脑保护；幼猪
Abstract:

Objective To evaluate the effect of ulinastatin on brain injury caused by deep hypothermic low-flow cardiopulmonary bypass(CPB) cardiac surgery in piglets. Methods 15 general-type piglets were divided into ulinastatin group (group U, n = 5), control group (group C, n = 5) and sham operation group (group S, n = 5), randomly. Routine CPB was established after median thoracotomy in group U and C under anesthesia. When the temperature of piglets dropped to 25 ℃, low-flow CPB （50ml.kg-1.min-1）began. After 120min of aortic cross-clamping, the aortic was declamped and finally weaned from CPB. Brain hippocampus tissue was harvested following 120min after CPB ceased, then the piglet was killed. 12,000 IU.kg-1 of ulinastatin was given instantly when CPB began and aortic declamp in group U respectively, and group C received equivalently normal saline. Brain hippocampus tissue was harvested after anesthesia and median thoracotomy in group S. Venous blood samples were taken immediately after anesthesia induction (T1) in all groups, 5min(T2) and 120min(T3) after the CPB shutdown in both Group U and C, and neuron-specific enolase (NSE), S100 protein β subtypes (S100β) and myelinbasicprotein (MBP) were tested by ELISA method. Pathology results of hippocampus were observed by light microscopy, and their water content were also measured. Results Totally 15 piglets got complete experiment end. In group C, compared with T1 timepoint, NSE, S100β, MBP were significantly increased by 30.2%, 32.3%, 62.0% and 33.1%, 29.8%, 57.1% in T2, T3 timepoints respectively(P <0.05). Compared with group C，NSE, S100β, MBP were significantly decreased by 16.8%, 7.3%, 20.4% and 20.4%, 2.7%, 18.5% respectively, in T2 and T3 timepoints in group U. (P <0.05). Brain injury was observed in both group U and C, and was lighter in group U. The water content of hippocampus was increased by 2.2% in group C than that of group U (P <0.05). Conclusions Deep hypothermic low-flow cardiopulmonary bypass surgery would result in brain injury on piglets, and ulinastatin could inhibit against those injury.
Key words: Cardiopulmonary bypass; Deep hypothermic low-flow; Heart surgery; Hlinastatin; Brain injury; Cerebral protection; Piglets