乌司他丁对幼猪深低温低流量体外循环心脏手术肾损伤的影响

目的：评价乌司他丁对幼猪深低温低流量体外循环（CPB）心脏手术肾损伤的影响.方法：北京长白幼猪15例,分为乌司他丁组（U组,n=5）、对照组（C组,n=5）和假手术组（S组,n=5）.U组和C组麻醉后正中开胸,常规建立CPB,体温降至25℃后,开始低流量循环（50 mL·kg-1·min-1）,主动脉阻断120 min后开放,停机后观察120 min,U组在CPB开始和循环开放即刻分别给予乌司他丁1.2万IU·kg-1,C组给予等量0.9％氯化钠溶液.S组麻醉后单纯开胸.实验动物在麻醉诱导后即刻（T1）、U组和C组在停机后5 min（T2）、120 min （T3）取静脉血,检测胱抑素C（CysC）、血肌酐（SCr）、尿素氮（BUN）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）.三组动物在实验结束时,测尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）,取肾组织行病理检查.结果：三组动物均完成至实验结束.三组动物在T1时点的CysC、SCr、BUN、IL-6、TNF-α差异均无统计学意义（均P＞0.05）;在T2时点,U组的CysC、SCr、BUN、IL-6、TNF-α此C组分别降低12.50％（P＞0.05）、2.97％（P＞ 0.05）、0.37％ （P＞ 0.05）、26.28％ （P＜ 0.05）、10.81％ （P＜0.05）;在T3时点,U组的CysC、SCr、BUN、IL-6、TNF-α分别比C组降低24.37％（P＜0.05）、17.20％（P＜0.05）、16.82％（P＜0.05）、18.12％（P＜0.05）、8.57％（P＞ 0.05）.与C组相比,U组尿NAG降低51.17％ （P＜0.05）.C组和U组均可见肾损伤,U组较轻,S组未见肾损伤.结论：深低温低流量CPB心脏手术对幼猪存在肾损伤,乌司他丁可通过抑制炎症反应来达到对抗肾损伤（肾保护）的作用.

The effect of ulinastatin on kidney injury caused by deep hypothermic low-flow cardiopulmonary bypass surgery in piglets

Objective： To evaluate the effect of ulinastatin on kidney injury caused by deep hypothermic low-flow cardiopulmonary bypass surgery in piglets. Methods： Fifteen Beijing Landrace piglets were divided into ulinastatin group （Group U, n=5）, control group （Group C, n=5） and sham operation group （Group S, n=5）, randomly. Routine CPB was established after anesthetized and median thoracotomy in group U and C. When the temperature of piglets dropped to 25 ℃, low-flow CPB （50 mL. kg-1. min-1） began. After 120 min of aortic cross-clamping, the circulation was reopened and adjusted, finally ceased CPB. Kidney tissue was harvested 120 min after CPB ceased. 12 000 IU. kg1 of ulinastatin was given instantly when CPB began and circulation reopened respectively in group U, and group C received normal saline equivalently. Kidney tissue was harvested after anesthesia and median thoracotomy in group S. Venous blood samples were taken immediately after anes- thesia induction （T1） in all groups, 5min （T2） and 120 rain （T3） after the CPB shutdown merely in both Group U and C, for the test of Cystatin C （CysC）, Serum SCratinine （SCr）, blood urea nitrogen （BUN）, interleukin-6 （IL-6）, and tumor necrosis faetor-α （TNF-α）. When the experiment was terminated, test of the urine N-acetyl-β- D-glucosaminidase （NAG） and pathological examination of kidney tissues were performed in all three groups. Results： All 15 piglets completed experiment end. There were no statistics differences of CysC, SCr, BUN, IL- 6, and TNF-a in all three groups （P〉0.05） in T1 timepoints. Compared with Group C, CysC, SCr, BUN, IL- 6, and TNF-α were significantly decreased respectively 12.50% （P〉0.05）, 2.97% （P〉0.05）, 0.37% （P〉0.05）, 26.28% （P〈0.05）, 10.81% （P〈0.05） in T2 timepoints and 24.37% （P〈0.05）, 17.20% （P〈0.05）, 16.82% （P〈0.05）, 18.12% （P〈0.05）, 8.57% （P〉0.05） in T3 timepoints in Group U. Compared with Group C, urine N-acetyl-β-D- glucosaminidase was significantly decreased 51.17% （P〈0.05） in Group U. Kidney injury was observed in both Group U and C, and was lighter in group U, but not with Group S. Conclusion： Deep hypothermic low-flow cardiopulmonary bypass surgery will result in kidney injury on piglets, and ulinastatin can inhibit against those injury by inhibiting the inflammatory response.