乌司他丁在体外循环中对肺保护作用的临床研究

目的研究乌司他丁在体外循环(CPB)心脏直视手术中对肺损伤的保护作用。方法选择40例心脏手术患者随机分为两组(各20例),试验组给乌司他丁2万U/k(g麻醉诱导后CPB前静脉推注一半,另一半预充体外循环机内),对照组不给药。分别于麻醉诱导前(T1),阻断升主动脉30m(inT2),CPB结束后1(hT3)、24(hT4)、36(hT5)取桡动脉血标本,动态检测两组患者各时间点肿瘤坏死因子-(aTNF-a)和白细胞介素-10(IL-10);麻醉诱导前(T1),CPB结束后1(hT3)、24(hT4)和36(hT5)测定动脉血气,对比观察术后肺泡-动脉血氧分压差(A-aDo2)及呼吸指数(RI)。术后1h、12h、36h常规拍胸片,以胸片中有明显斑片状阴影、肺不张为阳性,对比观察肺部并发症发生率。结果①两组一般资料差异均无统计学意义(P>0.05)。②CPB开始后,两组桡动脉血TNF-a、IL-10进行性增高。TNF-a于CPB结束后1h达到最高,后逐渐下降,但仍高于CPB前,对照组增高更显著(P<0.01)。IL-10于CPB结束后24h达到最高,后逐渐下降,但仍高于CPB前,试验组增高更显著(P<0.05)。③对照组T3、T4、T5的A-aDo2及RI明显高于试验组。试验组与对照组比较,术后肺泡-动脉血氧分压差及RI低(P<0.01)。④肺部并发症发生率:实验组:明显斑片状阴影2例,没有肺不张发生;对照组:明显斑片状阴影4例,肺不张1例。结论在体外循环过程中,乌司他丁可以通过抑制炎症因子TNF-a的产生,上调抗炎因子IL-10的释放,减轻肺损伤,改善术后肺功能。

Influence of ulinastatin on lungs in cardopulmonary bypass patients

Objective To investigate the protective effect of ulinastatin on lungs in cardiopulmonary bypass (CPB) patients. Methods 40 patients undergoing open-heart surgery under CPB were randomly divided into two groups: control group(n=20) and test group(n=20). The test group received the ulinastatin after anesthesia induction.Blood samples were drawn from radial arter before indution(T1),30 min following clamping(T2),1 h after CBP(T3),24 h after CBP(T4)and 36 h after CBP(T5). Tumor necrosis factor -a (TNF-a), interleukin-10(IL-10) were measured by ELISA perioperatively in both group. Alveolar-arterial oxygen gradient and Respiratory indexes(RI) were recorded T1,T3,T4,T5 . Chest X-rays pictures of chest were taken 1 h,12 h,36 h after operation for existence of pulmonary complications. Results There were no differences in the values of TNF-a,IL-10,A-aDo2 and RI at T1(base value) between the same time. After CPB,the levels of TNF-a,IL-10 increased compared with the T1 in both group. The plasma levels of TNF-a in the ulinastatin group were significantly lower than the control group(P<0.01). The plasma levels of IL-10 in the ulinastatin group were significantly higher than the control group(P<0.05). The RI of the control group at T3,T4,T5 were higher than both the base values and the values of group ulinastatin respectively(P<0.05). Compared with the control group, patients in the ulinastatin group showed lower rate of occurrence of pulmonary complications and lower A-aDo2 after operation(P<0.01). Conclusion Ulinastatin may significantly inhibit the inflammatory cytokine(TNF-a) release and significantly increase the anti-inflammatory cytokine(IL-10) release, and may protect lungs during cardiopulmonary bypass.