乌司他丁对非停跳冠状动脉搭桥术患者肺损伤的影响

目的探讨乌司他丁对非体外循环冠状动脉搭桥术(OPCABG)患者的肺损伤的影响。方法择期行OPCABG的患者30例,随机分为对照组(C组)和乌司他丁组(U组),每15例。U组麻醉诱导后恒速输注乌司他丁6000U/kg(30min内)后,再以1000U.kg-1.h-1的速率输注至手术结束;C组采用同样的方法输注等量0.9%氯化钠溶液。分别于麻醉后切皮前即刻(T1)、旁路血管开放时(T2)、术毕(T3)、术后8h(T4)监测MPAP、PCWP、SVO2、PVR等指标并计算出P(A-a)DO2、RI、QS/QT、VD/VT、Raw、PVR及CL等指标。并于相同时间点及术后24h(T5)抽取静脉血,测定血浆(IL-6、IL-10及TNF-α浓度及CD11b/CD18表达水平。结果与T1比较,2组在T3,T4时P(A-a)DO2、RI、Raw升高,T2～4时PVR升高、CL降低,在T2,T3时IL-6、CD11b/CD18表达升高,T2～5时TNF-α浓度升高(P<0.05或<0.01);与C组比较,U组在T3～4时P(A-a)DO2、RI、PVR降低,在T2～4时VD/VT、OI降低;在T2时CL升高(P<0.05或<0.01),U组在T3时IL-6、IL-10浓度降低,T2～5时TNF-α浓度和CD11b/CD18表达降低(P<0.05或<0.01)。结论乌司他丁可抑制OPCABG患者围手术期的IL-6、IL-10及TNF-α浓度及CD11b/CD18表达水平的升高,减轻肺损伤,达到肺保护的作用。

Effects of ulinastatin on the lung injury in patients undergoing off-pump coronary artery bypass graft surgery

Objective To investigate the effects of ulinastatin on the lung injury in patients undergoing off-pump coronary artery bypass graft （OPCABG）. Methods 30 patients undergoing selective OPCABG were double-blindly and randomly divided into ulinastatin group （group U, n = 15 ） and control group（ group C, n = 15）. Ulinastatin 6 000 U/kg was infused intravenously over 30min after anesthesia induction, then ulinastatin 1 000 U· kg^· h^-1 was continuously infused until the end of the operation in group U. However in group C, equal volume normal saline at the same infusion rate was infused instead of ulinastatin. The indexes including MPAP,PCWP,SVO2 and PVR were detected respectively before operation （ T1 ）, at the time of opening vessel bypass （1＂2）, at the end of the operation （T3） and 8h after the operation （T4）. The indexes of lung function, including P（A-a） DO2, RI, QS/QT, VD/VT, Raw, PVR and CL were calculated. The venous blood samples were taken at the different time points （T1 ,T2 ,T3 ,T4） and 24h after operation （T5）, and the plasma levels of IL-6, IL-10,TNF-α and CDllb/CD18 were detected. Results As compared with baseline values （T1） ,P（A-a） DO2, RI and Raw at T3-4,PVR at T2-4,IL-6,CDllb/CD1 at T2,3 ,TNF-ot at T2-5 were significantly increased in both groups （ P 〈 0.05）. At the same time, CL at 13 was obviously decreased in both groups （ P 〈 0.05 ）. As compared with those in group C,P（A-a） DO2,RI and PVR at 13 ~4,VD/VT and OI at T2-T4,IL-6 and IL-10 at 13, TNF-α and CD11 b/CD18 at T2- 5 were significantly decreased in group U （ P 〈 0.05 ）. CL at T2 in group U was significantly higher than that in group C （ P 〈 0.05）. Conclusion Ulinastatin can relieve lung injury and protect lung function in patients undergoing OPCABG at perioperative period by inhibiting the expressions of IL-6, IL-10,TNF-α and CDllb/CD18.