乌司他丁对法洛四联症矫治术患儿S100β蛋白和神经元特异性烯醇化酶的影响

Effect of ulinastatin on the expression of S100β protein and neuron-specific enolase in infants undergoing corrective surgery for tetralogy of Fallot

中文关键词: 患儿  法洛四联症  乌司他丁  S100β蛋白  神经元特异性烯醇化酶

英文关键词: Infant  Tetralogy of Fallot  Ulinastatin  S100β protein  Neuron-specific enolase

中文摘要:

      
目的 观察乌司他丁对患儿法洛四联症(tetralogy of Fallot, TOF)矫治术中血浆S100β蛋白和神经元特异性烯醇化酶(NSE)浓度的影响。
方法 选择择期行心肺转流(cardiopulmonary bypass, CPB)下一期矫治术的TOF患儿40例,男25例,女15例,3～12月龄,采用密封随机分组信封法分为两组: 乌司他丁组(U组)和对照组(C组),每组20例。两组麻醉诱导、维持及围术期用药相同,U组麻醉诱导后静脉给予乌司他丁10 000 U/kg, CPB预充液中加入20 000 U/kg;术后第1天开始应用乌司他丁30 000 U·kg^-1·d^-1,直至出ICU时停药。记录患儿CPB时间,并于诱导时(T1)、停CPB(T2)、术后24 h(T3)、术后48 h(T4)抽取静脉血3 ml,采用ELISA法测定血浆S100β蛋白和NSE浓度。
结果 T1时两组S100β蛋白及NSE浓度均在正常范围内。与T1时比较,T2时两组S100β蛋白和NSE浓度明显升高(P<0.05),且达到峰值; T3—T4时两组S100β蛋白浓度明显下降(P<0.05);T3时两组NSE浓度明显降低（P<0.05）,T4时基本恢复至T1时水平。
结论 在TOF患儿CPB术中,乌司他丁可降低血浆中脑损伤标志物S100β蛋白和NSE浓度,从而产生一定的脑保护作用。

英文摘要:

      
Objective To compare the clinical effects of ultrafast track anesthesia and traditional anesthesia for congenital heart disease in children with low-weight, and to explore the superiority of ultrafast track anesthesia.
Methods One hundred and fourteen pediatric patients with congenital heart disease and low birth weight (5 - 10 kg) in our hospital, 54 males and 60 females, falling into ASA physical status Ⅲ or Ⅳ, were randomly divided into the ultrafast track anesthesia group and traditional anesthesia group, 57 cases in each group. The patients in the traditional anesthesia group were treated with conventional anesthesia. The patients were directly sent to the ICU with endotracheal tube after the operation. Others were treated with the ultrafast track anesthesia sevoflurane was stopped before the extracorporeal circulation. At the beginning of rewarming we stopped the infusion of cis-atracurium, and gave intravenous remifentanil 0.3 μg·kg^-1·min^-1. At the onset of skin suture, propofol and remifentanil were stopped. Dexmedetomidine was given continuously and intravenously with the speed of 1 μg·kg^-1·h^-1 until to the ICU. At the end of the operation, 0.375％ ropivacaine was used for intercostal nerve block and subcutaneous infiltration in the skin incision and drainage incision. The patients were also given intravenous aminophylline 2 - 4 mg/kg, sputum suction and inducing spontaneous breath in SIMV mode. The ehdotracheal tube was removed within 10 min after the operation, and patients was sent to the ICU with facemask. Postoperative extubation time, ICU time and postoperative hospital stay were recorded. Sedation-agitation scores (SAS) were recorded at the extubation time and 6, 12, 24 h after extubation. The incidence of airway obstruction in the patients of ultrafast track anesthesia group was recorded.
Results The extubation time, ICU time and postoperative hospital time in the ultrafast track group were significantly less than that of the traditional anesthesia group (P < 0.05). The SAS score at the extubation time in the ultrafast track anesthesia group was obviously lower than that of the traditional group. There were no significant differences between the two groups 6, 12 and 24 h after surgery. There were no significant complications (airway obstruction) in the two groups.
Conclusion Compared with the traditional anesthesia group, ultrafast track aneshesia was safe for congenital heart disease in children with low-weight, which could shorten postoperative extubation time, ICU time and postoperative hospital stay, reduce postoperative hospitalization costs, but not increase the incidence of postoperative airway obstruction and agitation.