乌司他丁对体外循环瓣膜置换术患者肺功能的保护作用

目的研究乌司他丁（UTI）对体外循环（CPB）心脏瓣膜置换术患者肺功能的保护机制。方法择期行心脏瓣膜置换术患者42例,随机分成对照组、低剂量UTI组（8000U/kg）和高剂量UTI组（12000U/kg）。手术过程中在体外循环加入不同剂量的UTI,对照组用等量生理盐水代替。观察手术切皮前（T1）、停用CPB1h（T2）、4h（T3）、24h（T4）时间点肺功能指标气道峰压（PIP）、气道平台压（Pplat）、肺泡-动脉氧分压差（AaDO2）、肺静态顺应性（Cs）、肺动态顺应性（Cd）的变化。结果对照组术后PIP、Pplat、AaDO2较CPB前显著增加（P〈0.05）,而Cs、Cd均下降（P〈0.05）。术后T2、T3时点两UTI试验组的PIP、Pplat、AaDO2值均明显低于对照组（P〈0.05）,而Cs、Cd值较对照组显著增加（P〈0.05）。高剂量UTI组在T2、T3时点PIP、Pplat、AaDO2分别较低剂量UTI组显著降低（P〈0.05）,而Cs、Cd在上述时点较低剂量UTI组增加（P〈0.05）。结论在CPB瓣膜置换术中,UTI能减轻肺损伤,改善肺功能。在体外循环肺损伤的保护方面,UTI12000U/kg作用明显优于8000U/kg,呈剂量效应关系。

Ulinastatin Alleviates Lung Injury during Cardopulmonary Bypass in Patients Underwent Valve Replacement Surgery

Objective To study the protective effects of ulinastatin（UTI）on lung function after cardiopulmonary bypass（CPB）.Methods 42 Patients,ASA score Ⅱ~Ⅲ,scheduled for elective cardiac valve replacement,were randomly allocated into three groups,ie.a control group,a low dose UTI group（UTI 8000U/kg）,and a high dose UTI group（UTI 12 000 U/kg）.Inspiratory pressure（PIP）,Plateau pressure（Pplat）,alveolar-arterial oxygen pressure difference（AaDO2）,static lung compliance（Cs）and dynamic lung compliance（Cd）were recorded before operation（T1）and at 1 hour（T2）,4 hours（T3）,24 hours（T4）after CPB termination.Results Compared with pre-CPB,postoperative PIP,Pplat and AaDO2 increased,and Cs and Cd decreased significantly in the control group（all P0.05）.Compared with the control group at T2~T3,postoperative PIP,Pplat,AaDO2 were significantly lower（P0.05）,and Cs and Cd were significantly higher in the two UTI groups（P0.05）.Compared with the low dose UTI group at T2~T3,the PIP,Pplat and AaDO2 were significantly reduced（P0.05）,and the Cs and Cd were significantly increased in the high dose UTI group（P0.05）.Conclusion UTI can alleviate lung injury and improve lung function during valve replacement surgery with CPB in a dose dependent manner.