目的探讨盐酸戊乙奎醚( PHC)对体外循环( CPB)心脏手术患者术后全身炎症反应的影响。方法择期体外循环下行心脏手术患者40例,心功能NYHA分级II~III级,按照随机数字法分为观察组和对照组,每组20例。观察组患者麻醉诱导前静脉注射PHC 0.03 mg/kg;对照组患者相同时间点注射等容量的生理盐水。分别于麻醉诱导前( T0)、手术结束时( T1)、手术后6 h( T2)、12 h ( T3)、24 h( T4)等5个时间点测定血浆IL-8、TNFα和NF-κB等水平。记录麻醉药物用量;记录患者气管导管留置时间、ICU住院时间、术后住院时间等临床指标。结果 T1至T4两组血浆IL-8和TNFα浓度显著升高( P<0.05),观察组IL-8和TNFα浓度显著低于对照组( P<0.05)。 T1至T4两组血浆NF-κB浓度显著升高( P<0.05),观察组NF-κB浓度显著低于对照组( P<0.05)。观察组患者术后留置气管导管时间、ICU住院时间和术后总住院时间均小于对照组,但两组间差异无统计学意义( P>0.05)。结论 PHC对CPB下心脏手术患者的系统性的炎症反应具有一定的抑制效应,其机制与其调控NF-κB信号通路的活性、减少IL-8和TNFα等炎性介质的释放有关。
[ Abstract]:Objective To investigate effects of penehyclidine hydrochloride ( PHC) on systemic inflammatory reaction in pa?tients undergoing cardiac surgery with cardiopulmonary bypass ( CPB) . Methods Forty patients undergoing cardiac surgery with car?diopulmonary bypass were enrolled in the study. All patients were randomly divided into trial group and control group ( twenty in each group). Patients in trial groupreceived an intravenous injection of 0.03 mg/kg PHC before anesthesia induction and those in control group were given the same volume of normal saline. Blood samples were collected at the following time points:before anesthesia induc?tion ( T0) , the end of the operation ( T1) , 6 hours ( T2) , 12 hours ( T3) and 24 hours postoperatively ( T4) for the measurement of IL-8, TNFα and NF-κB. The outcomes included duration of intubation ( DOI) , length of intensive care unit stay ( LOI) and length of hospital stay after the surgery ( LOH) . Results The plasma levels of IL-8 and TNFα increased significantly from T1 to T4 in both groups, and those in trial group were statistical lower than control group from T1 to T4 ( P<0.05). The plasma level of NF-κB in?creased significantly from T1 to T4 in both groups, and those in trial group were lower than control group from T1 to T4 ( P<0.05). The DOI, LOI and LOH in trial groupwere shorter than control group, but there were no statistically significant between two groups ( P>0.05) . Conclusion PHC inhibits systemic inflammatory response in patients undergoing cardiopulmonary bypass, and its mecha?nisms is relevant to the regulation of NF-κB signal way on the production of proinflammatory cytokinesas,like IL-8 and TNFα.