抑肽酶对体外循环心脏手术的肺保护作用

目的探讨体外循环心脏手术后肺的损伤情况和抑肽酶的保护作用。方法 2 4例风湿性心脏瓣膜疾病患者随机分为两组 ,每组 12例 ,试验组术中于预充液内一次性加入抑肽酶 4 0 0万KIU;对照组除不用抑肽酶外 ,其它条件同试验组。动态监测所有患者血清补体 (C3、C4 )、白细胞计数和多形核白细胞跨肺差值 ;记录两组患者术后呼吸机应用时间。结果两组患者术前、转流 2 0分钟、停机和术毕上述各实验室参数组间比较差异无显著意义 (P >0 0 5 ) ,但手术开始后均明显低于术前 (P <0 0 5或P <0 0 1) ;升主动脉开放后 5分钟、10分钟和 15分钟 ,两组多形核白细胞跨肺差值明显大于转流前 (P <0 0 1) ,试验组多形核白细胞跨肺差值明显小于对照组 (P <0 0 5或P <0 0 1) ;试验组应用呼吸机的时间明显少于对照组 (P <0 0 1)。结论体外循环心脏手术由于补体激活 ,白细胞的趋化性增强并隔离于肺组织中 ,从而引起肺损伤。抑肽酶有减轻肺组织炎性反应 ,保护机体肺功能的作用

Effects of aprotinin on lung protection at cardiopulmonary bypass patients

Objective To investigate the effects of aprotinin on lung protection at cardiopulmonary bypass(CPB) patients. Methods 24 cases rheumatic heart valve disease patients underwent valve replacement with cardiopulmonary bypass were divided into test group and control group. The paramenters of the complement 3 (C 3),complement 4 (C 4); leukocyte count, difference of transpulmonary olymorphonuclear leukocyte were measured during the perioperative period and the time of used respirator were recorded.Results The changes of the difference of transpulmonary polymorphonuclear leukocyte in test group were significantly lower on 5min, 10min, 15min after aorta was unclamped than those in control group ( P <0.05 or P <0.01) and the changes in the both groups during and after operation were significantly higher than before CPB( P <0.01). Conclusion Aprotinin has a better inhabitor at systemic inflammatory responses syndrome and advantageous effects on lung protection at cardiopulmonary bypass patients.