Xiao X, Luo C, Zhuang X, Yin D, Chen Y, Cao G, Huang X, Tian Z, Shi Y
Division of Cardiothoracic Surgery, First Affiliated Hospital, WCUMS, Chengdu 610041, China.
Hua Xi Yi Ke Da Xue Xue Bao. 2001 Jun;32(2):291-3.
To explore the effect of amrinone and aprotinin on whole-body inflammatory response in the patients with prosthetic valve replacement during perioperative period.
24 patients undergoing prosthetic valve replacement were randomized to control group (group A, n = 8), aprotinin group (group B, n = 8) and amrinone combined with aprotinin group (group C, n = 8). In the aprotinin group, 3 x 10(6) of aprotinin was added to the priming solution of the extracorporeal circulation (ECC). In the amrinone combined with aprotinin group 3 x 10(6) of aprotinin was added to the priming solution of the ECC and amrinone began with a bolus of 1 mg/kg followed by a maintenance infusion of 8 micrograms/(kg.min). The control group received an equivalent prime volume without aprotinin. Venous blood samples were drawn before the operation, at the end of ECC, 1 hour after the end of ECC, and one day after the operation respectively. Enzyme-linked immunosorbent assay techniques were used to measure each of the cytokines.
Before ECC, there were no differences of the levels of IL-6 and IL-8 among groups (P > 0.05). After ECC, the levels of IL-6 and IL-8 increased significantly in all groups (P < 0.05). The levels on day one after the operation were still higher than those before the operation in all groups (except the level of IL-8 in group C), but no statistical significance was observed. (P > 0.05). At 1 hour after the end of ECC, the level of IL-6 in group B was lower than that in group A, and the level of IL-6 in group C was lower than that in group B, but there was no statistically significant difference (P > 0.05); At the end of ECC, the level of IL-8 in group B was lower than that in group A and the level of IL-8 in group C was lower than that in group B, but no significant difference was noted (P > 0.05). It was also observed that the level of IL-8 was lower in group C than group A or B at 1 hour after the end of ECC.
Although amrinone and aprotinin have antiinflammatory activity, but pump prime only aprotinin or aprotinin combined with amrinone may fall in preventing proinflammatory cytokine release (IL-6, IL-8) completely in patients with prosthetic valve replacement during ECC perioperative period.
探讨氨力农和抑肽酶对人工瓣膜置换术患者围手术期全身炎症反应的影响。
将24例行人工瓣膜置换术的患者随机分为对照组（A组，n = 8）、抑肽酶组（B组，n = 8）和氨力农联合抑肽酶组（C组，n = 8）。抑肽酶组在体外循环（ECC）预充液中加入3×10⁶单位抑肽酶。氨力农联合抑肽酶组在ECC预充液中加入3×10⁶单位抑肽酶，氨力农先静脉推注1mg/kg，随后以8μg/（kg·min）维持输注。对照组输注等量不含抑肽酶的预充液。分别于手术前、ECC结束时、ECC结束后1小时及术后1天采集静脉血样本。采用酶联免疫吸附测定技术检测各细胞因子水平。
ECC前，各组IL-6和IL-8水平差异无统计学意义（P > 0.05）。ECC后，各组IL-6和IL-8水平均显著升高（P < 0.05）。术后1天，各组（C组IL-8水平除外）上述指标仍高于术前，但差异无统计学意义（P > 0.05）。ECC结束后1小时，B组IL-6水平低于A组，C组IL-6水平低于B组，但差异无统计学意义（P > 0.05）；ECC结束时，B组IL-8水平低于A组，C组IL-8水平低于B组，但差异无统计学意义（P > 0.05）。同时观察到ECC结束后1小时C组IL-8水平低于A组和B组。
虽然氨力农和抑肽酶具有抗炎活性，但在ECC围手术期，单独泵注抑肽酶或抑肽酶联合氨力农可能无法完全防止人工瓣膜置换术患者促炎细胞因子（IL-6、IL-8）的释放。
