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目的研究围手术期应用乌司他丁(UTI)对老年患者器官功能保护方面的作用及保护机制。方法选择择期上腹部手术老年患者80例,随机分为2组,各40例。U组患者于术前1 d开始用UTI 2.0万U·kg~(-1)加入50 mL生理盐水中用微泵注射,qd,使用至术后第5天止,手术日开放中心静脉后立即用微量泵快速泵入UTI;C组均以50mL生理盐水代替UTI使用,其他常规治疗同U组。并选择不同时间点检测患者的血清TNF-α、IL-6及HO-1;分别检测两组术前1 d及术后1、3、5 d血清TNF-α、IL-6、IL-8,即时记录两组患者术后体温变化情况。结果应用2.0万U·kg~(-1) UTI后U组在不同时间点IL-6、TNF-α的各项检验值均显著低于C组(P<0.05);且术后12、24 h的HO-1活性显著升高,两组间对比差异有统计学意义(P<0.05)。结论 UTI具有抑制促炎因子释放作用,同时可降低患者体内促炎因子TNF-α、IL-6、IL-8的水平,促进HO-1反应性上调,发挥抗缺血-再灌注损伤能力,从而起到脏器保护作用。
Objective To study the effect of perioperative application of ulinastatin (UTI) on organ function in elderly patients and its protective mechanism. Methods Eighty elderly patients undergoing elective upper abdominal surgery were randomly divided into 2 groups (n = 40). Patients in group U were injected with 50 mL of UTI at a dose of 20 000 U · kg ~ (-1) UTI at 1 day before operation by micro-pump, qd, until the fifth day after operation, immediately after the opening of the central vein on the operation day UTP pump with rapid pump; C group were treated with 50mL saline instead of UTI, other conventional treatment with the U group. Serum levels of TNF-α, IL-6 and HO-1 were detected at different time points. The levels of TNF-α, IL-6 and IL-8 , Real-time recording of postoperative changes in body temperature in both groups. Results The values of IL-6 and TNF-α in U group were significantly lower than those in C group (P <0.05) at UU of 20 000 U · kg -1 at 12, 24 h HO-1 activity was significantly increased, the difference between the two groups was statistically significant (P <0.05). Conclusions UTI can inhibit the release of proinflammatory cytokines and reduce the levels of TNF-α, IL-6 and IL-8 in patients with UTIs, promote the reactivity of HO-1 and exert anti-ischemia-reperfusion injury, Thus play a role in organ protection.