Nakanishi Kazuhiro, Takeda Shinhiro, Sakamoto Atsuhiro, Kitamura Akira
Department of Anesthesiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
Crit Care Med. 2006 May;34(5):1351-7. doi: 10.1097/01.CCM.0000215110.55899.AE.
To examine the association between decreased release of proinflammatory cytokines in response to urinary trypsin inhibitor pretreatment and decreased myocardial and lung injury after cardiopulmonary bypass.
A prospective, randomized, double-blind study.
University hospital.
Thirty patients on cardiopulmonary bypass undergoing coronary artery bypass grafting.
Patients received 5000 units/kg intravenous urinary trypsin inhibitor (n = 15) or 0.9% saline (control, n = 15) immediately before aortic cannulation for cardiopulmonary bypass.
Neutrophil elastase, tumor necrosis factor-alpha, interleukin-6, and interleukin-8 were measured after intubation (T1), immediately before aortic cannulation (T2), after separation from cardiopulmonary bypass (T3), at the end of surgery (T4), and on postoperative days 1 (T5), 3 (T6), and 5 (T7). Simultaneous hematocrit values were obtained at all sample times. Isoenzyme of creatine kinase with muscle and brain subunits, troponin-T, and myosin light chain I were also measured. Various hemodynamic and pulmonary data were obtained perioperatively. Levels of neutrophil elastase and cytokines were corrected for hemodilution. Interleukin-6 and interleukin-8 levels were lower at T3 and T4 in the urinary trypsin inhibitor group than in the control group. Stroke volume index was significantly decreased in the control group at T3, and statistical difference was found between groups at T3 (p < .01). Respiratory index and intrapulmonary shunt were significantly higher in the control group than in the urinary trypsin inhibitor group at T3. Changes in respiratory index and intrapulmonary shunt correlated with interleukin-8 levels at T3 (r = .52, p < 00001; r = .37, p < 0001, respectively) and T4 (r = .44, p < .001; r = .24, p < .05, respectively). Neutrophil elastase levels and cardiac marker responses to coronary artery bypass grafting surgery were similar in both groups.
Prepump administration of urinary trypsin inhibitor attenuates the elevation of interleukin-6 and interleukin-8 release immediately after cardiopulmonary bypass.
研究尿胰蛋白酶抑制剂预处理后促炎细胞因子释放减少与体外循环后心肌和肺损伤减轻之间的关联。
一项前瞻性、随机、双盲研究。
大学医院。
30例行体外循环冠状动脉搭桥术的患者。
在体外循环主动脉插管前，患者分别接受5000单位/千克静脉注射尿胰蛋白酶抑制剂（n = 15）或0.9%生理盐水（对照组，n = 15）。
在插管后（T1）、主动脉插管前即刻（T2）、体外循环结束后（T3）、手术结束时（T4）以及术后第1天（T5）、3天（T6）和5天（T7）测量中性粒细胞弹性蛋白酶、肿瘤坏死因子-α、白细胞介素-6和白细胞介素-8。在所有采样时间同时获取血细胞比容值。还测量了含有肌肉和脑亚基的肌酸激酶同工酶、肌钙蛋白-T和肌球蛋白轻链I。围手术期获取各种血流动力学和肺部数据。对中性粒细胞弹性蛋白酶和细胞因子水平进行血液稀释校正。尿胰蛋白酶抑制剂组在T3和T4时白细胞介素-6和白细胞介素-8水平低于对照组。对照组在T3时每搏量指数显著降低，且两组在T3时存在统计学差异（p < .01）。对照组在T3时呼吸指数和肺内分流显著高于尿胰蛋白酶抑制剂组。呼吸指数和肺内分流的变化与T3时白细胞介素-8水平相关（r = .52，p < .00001；r = .37，p < .0001）以及T4时（r = .44，p < .001；r = .24，p < .05）。两组中性粒细胞弹性蛋白酶水平以及冠状动脉搭桥术心脏标志物反应相似。
体外循环前给予尿胰蛋白酶抑制剂可减轻体外循环后即刻白细胞介素-6和白细胞介素-8释放的升高。
