非体外循环心脏手术凝血酶和血小板的激活及乌司他丁的影响

目的观察非体外循环冠状动脉旁路移植术(OPCABG)患者围术期凝血酶和血小板的激活情况及乌司他丁对此的影响。方法采取随机、双盲、对照的方法将40例OPCABG患者分为对照组(C组)和乌司他丁组(U组),每组20例。U组:麻醉诱导后开始恒速静脉泵入6 000 U/kg的乌司他丁,30 min内输完,然后以1 000 U/(kg.h)的速度持续静脉泵入至手术结束。C组:给予相同容积的生理盐水。分别在切皮前(T1)、术后即刻(T2)、术后2 h(T3)、6 h(T4)、术后18 h(T5)测定血小板α颗粒膜蛋白(GMP-140)和尿纤维蛋白肽(uFPA)浓度,并记录患者的术后24 h胸液量等临床资料。结果与T1比较,两组在T2和T3时点uFPA浓度和在T3、T4和T5时点GMP-140浓度均显著升高(P0.05);组间比较差异均无统计学意义(P0.05)。结论 OPCABG患者围术期存在凝血酶和血小板激活,乌司他丁对此无明确保护作用。

Effect of ulinastatin on thrombin and platelet activation in the patients during off-pump coronary artery bypass graft surgery

OBJECTIVE To investigate the effects of ulinastatin on perioperative thrombin and platelet activation in the patients undergoing off-pump coronary artery bypass graft surgery（OPCABG）.METHODS Forty low risk patients undergoing OPCABG were divided in a double-blind and randomized fashion into 2 groups（n=20 each）： control group（C） and ulinastatin group（U）.Anesthesia was induced with midazolam 0.1mg/kg,fentanyl 10-20μg/kg and pancuronium 0.1 mg/kg,and maintained with 1%-2% isoflurane and intermittent IV boluses of fentanyl and pancuronium.Ulinastatin 6000 U/kg in 50 ml of normal saline was infused intravenously over 30 min after induction of anesthesia followed by continuous infusion of ulinastatin at 1000 U/（kg·h） until the end of the operation.In group C,the equal volume of normal saline was infused instead of ulinastatin.Venous blood and urine samples were taken before operation（T1）,at the end of operation（T2）,and 2 h（T3）,6 h（T4）,and 18 h（T5） after the operation for determination of plasma α-granule membrane protein-140（GMP-140） and urine fibrinopeptide A（uFPA） concentration.RESULTS Plasma concentration of GMP-140 at T3-5 and uFPA concentration at T2,3 were significantly increased compared with baseline value at T1 in both groups,but there was no significant difference between 2 groups.CONCLUSION Current data suggested that Ulinastatin cannot inhibit the thrombin and platelet activating during and after operation in the patients undergoing OPCABG.