乌司他丁对体外循环心脏直视手术患者血浆IL-6的影响

目的 观察乌司他丁(ulinastatin,UTI)对体外循环(Cardiopulmonary bypass,CPB)心脏直视手术患者血浆IL-6的影响,以了解UTI对CPB所致的肺损伤是否具有保护作用.方法 选择40例主动脉阻断时间在30 min以上的心脏直视手术患者,随机分为实验组(U组)20例,对照组(C组)20例.U组按1.2万u/kg体重计算UTI用量,分别在麻醉诱导和CPB开始时按0.6万u/kg静注UTI共两次,C组用等量生理盐水替代,用法同U组.分别于麻醉诱导前(T0),CPB 10min(T1),CPB 30 min(T2),CPB结束后1 h(T3),CPB结束后3 h(T4),CPB结束后6 h(T5)抽取桡动脉血,用ELISA法测定血浆白细胞介素-6(IL-6)的浓度.同时测定T0、T3、T4、T5等时间点的血浆肺泡动脉血氧分压差(A-aDO2).结果 两组患者T1至T5IL-6均较T0明显升高(P＜0.05),均在T4达高峰.T3至T5两组A-aDO2均较T0明显升高(P＜0.05),A-aDO2在T4达高峰.U组T1至T5时IL-6和T3至T5时A-aDO2均明显低于C组(P＜0.05).结论 UTI可明显减少CPB术后IL-6的过度释放,减轻术后肺泡动脉血氧分压差,对改善肺氧合保护肺功能有一定的作用.

The Effect of Ulinastatin on the Plasma IL-6 of the Patients in Cardiopulmonary Bypass

Objective To investigate whether Ulinastin can reduce the heart muscle ischemia reperfusion injury induced by cardiopulmonary bypass. Methods Forty patients scheduled for cardiac surgery were randomly allocated into two groups,Ulinastatin group(group U,n=20) and control group(group C,n=20).Group U in which patients received a total of 12000 u/ kg of ulinastatin.6000 u/ kg ulinastatin was given a IV bolus on introduction of anesthesia and before CPB.Group C in which patients received an equal amount of isotonic sodium chloride solution.Blood samples were taken from radial artery before introduction of anesthesia(T0),10 min after initiation of CPB(T1),30 min after initiation of CPB(T2),1 h(T3),3 h(T4) and 6 h(T5) after CPB for determination of plasma IL6 concentrations.Alveolar-arterial oxygen A-aDO2 were checked at T0,T3,T4,T5.Results There was no significant difference between two groups in age, weight,operation time,CPB time,and aortic cross-clamping time.Compared with those at T0,the concentrations increased significantly at T1-T5 in two groups(P<0.05).There was no difference between two groups at T0.The concentrations of IL-6 at T1-T5,A-aDO2 at T3-T5 in group U was lower than those in group C significantly (P<0.05).Conclusion Ulinastatin suppressed the excessive release of IL-6 and protected lung injury in patients undergoing cardiopulmonary bypass.