乌司他丁对体外循环下心肌缺血再灌注损伤患者基质金属蛋白酶-9的影响

目的观察乌司他丁对体外循环(ECC)下心肌缺血再灌注损伤患者围术期基质金属蛋白酶-9(MMP-9)的影响。方法 30例择期心脏手术患者,随机分为两组:对照组和乌司他丁组,每组15例。乌司他丁组按12 ku/kg计算乌司他丁用量,分别在麻醉诱导和ECC开始时按6 ku/kg静注乌司他丁共两次,对照组用等量生理盐水替代,用法同乌司他丁组。分别在ECC开始前(T1)、主动脉阻断前1 min(T2)、主动脉开放后1 min(T3)、ECC结束时(T4)、ECC结束后2 h(T5)及6 h(T6)这6个时间点各采集5 ml动脉血,用ELISA法测定血浆MMP-9的浓度。结果主动脉阻断前1 min至ECC结束后6 h两组患者MMP-9浓度均较ECC开始前(T1)明显升高(P0.05),两组MMP-9浓度均在ECC结束时(T4)达高峰,两组MMP-9浓度在ECC开始前(T1)差异无显著性。乌司他丁组主动脉阻断前1 min至ECC后6 h MMP-9的浓度均明显低于对照组(P0.05)。结论乌司他丁能明显减轻ECC下心肌再灌注损伤患者围术期MMP-9的过度释放。

Effects of ulinastatin on the level of matrix metalloproteinase-9 in patients suffering from ischemic-reperfusion injury after extracorporeal circulation

OBJECTIVE To observe the effects of ulinastatin on the level of matrix metalloproteinase-9 in Patients suffering from ischemic-reperfusion injury after extracorporeal circulation（ECC）.METHODS 30 patients,were randomly divided into two groups,Ulinastatin group（n=15） and control group（n=15）.Ulinastatin group in which patients received a total of 12 ku/kg of ulinastatin.6 ku/kg ulinastatin was given on introduction of anesthesia and before ECC.The control group received an equal amount of isotonic sodium chloride solution.Blood samples were taken from artery before ECC,1 min before the aorta block,1 min after the aorta block,after ECC,2 h and 6 h after ECC for determination of plasma matrix metalloproteinase-9 concentrations.RESULTS Compared with those before ECC,the concentrations of matrix metalloproteinase-9 increased significantly between 1 min before the aorta clamping and 6 h after ECC in both two groups（P〈0.05）.And reached a maximal level in the end of ECC.There was no difference between two groups before ECC.The concentrations of MMP-9 between 1 min before the aorta clamping and 6h after ECC in ulinastatin group was lower than those in control group significantly（P〈0.05）. CONCLUSION Ulinastatin suppressed the excessive release of matrix metalloproteinase-9 in patients suffering from ischemic-reperfusion injury during ECC.