乌司他丁对心内直视手术患者红细胞脂质过氧化的影响

目的：观察乌司他丁对心内直视手术患者红细胞脂质过氧化损伤的保护作用。方法：选择20例首次择期行心脏瓣膜置换术患者，随机分为对照组(C组)和乌司他丁组(W组)，每组各10例。分别于诱导后切皮前（T1）、转流后30 min（T2）、停体外循环时（T3）、主动脉开放后30 min（T4）、术毕24 h（T5）抽取动脉血，测定血浆丙二醛（P-MDA）含量，每个红细胞丙二醛（E-MDA）含量,红细胞超氧化物歧化酶（E-SOD）活性。结果：C组体外循环开始，P-MDA,E-MDA即开始升高，至术毕24 h仍未恢复至术前水平(P<0.001)；W组P-MAD,E-MDA含量在主动脉开放30 min（T4）时，较术前明显增高(P<0.001)，至术毕24 h已基本恢复至术前水平。两组E-SOD活性在转流30 min时高于术前水平,C组其他时点均低于术前水平(P<0.001)，W组仅在T4时低于术前水平;但C组相应时点P-MDA,E-MDA均高于同时点W组，E-SOD活性明显低于W组（P<0.05）。结论：体外循环期间使用乌司他丁能减轻红细胞脂质过氧化损伤。

Effects of ulinastatin on erythrocyte lipid peroxidation in patients undergoing open heart surgery

OBJECTIVE: To investigate the effects of ulinastatin on erythrocyte lipid peroxidation in patients undergoing open heart surgery. METHODS: Twenty adult patients with rheumatic heart disease undergoing elective value replacement were divided randomly into 2 groups of 10 patients each: a control group (group C) and an ulinastatin group (group W). The patients were premedicated with intramuscular morphine 0.08 mg/kg and scopolamine 0.06 mg/kg. Anesthesia was induced with midazolam 0.1 mg/kg, fentanyl 5 microg/kg and vecuronium 0.1 mg/kg. After the tracheal intubation, the patients were mechanically ventilated. Anesthesia was maintained with midazolam, fentanyl and isoflurane. Blood samples were taken from radial artery before the operation (T1), 30 min after the initiation of CPB (T2), at the end of the CPB (T3), 30 min after the aorta declamping (T4) and 24 h after the operation (T5) for the determination of plasma and erythrocyte MDA (P-MDA and E-MDA) and erythrocyte SOD (E-SOD). RESULTS: The levels of P-MDA and E-MDA increased significantly after the initiation of CPB and the level of E-SOD was higher than the baseline level at T2, and then decreased from T3 to T5 in group C (P <0.001). The levels of P-MDA and E-MDA didn't increased until T4 (P <0.001) and returned to the baseline level at T5 in group W. The levels of P-MDA and E-MDA were significantly higher in group C than those in group W and the level of E-SOD was markedly lower than that in group W (P <0.05). CONCLUSION: Ulinastatin can alleviate erythrocyte lipid peroxidation in patients undergoing open heart surgery.