乌司他丁联合丙氨酰谷氨酰胺对体外循环瓣膜置换术患者的肺保护作用

目的探讨乌司他丁联合丙氨酰谷氨酰胺对体外循环瓣膜置换术患者肺泡毛细血管膜屏障功能的影响。方法拟在体外循环(Cardiopulmonary bypass,CPB)下行心脏瓣膜置换术患者40例,年龄40~60岁,ASAⅡ或Ⅲ级,采用随机数字表法,将患者随机分为乌司他丁组(U组)和乌司他丁联合Ala-GLn组(UA组),每组20例。麻醉诱导后,UA组泵注丙氨酰谷氨酰胺0.4 g/(kg·d),U组泵注等量的复方氨基酸注射液,两组持续输注24 h,并均在转流液内加入乌司他丁2万U/kg。分别在麻醉后(T_0)、CPB前(T_1)、开放主动脉30 min(T_2)、闭合胸骨(T_3)及术后5 h(T_4)、24 h(T_5),经颈内静脉采血3 mL,用于测定血浆TNF-α、IL-6和SP-A的含量;经动脉采血进行血气分析;观察术后机械通气时间。结果与T0时比较,两组患者在T2~T5时的血清TNF-α、IL-6含量均升高(P<0.05);UA组患者血浆TNF-α、IL-6含量低于U组(P<0.05)。与T_0时比较,两组患者在T_2~T_5时SP-A水平显著升高(P<0.05),UA组患者血浆SP-A含量低于U组(P<0.05);与T_0时比较,两组患者在T_2~T_5时A-aDO_2、RI值显著升高(P<0.05),UA组患者A-aDO_2、RI值低于U组(P<0.05);UA组术后机械通气时间较U组缩短(P<0.05)。结论乌司他丁联合丙氨酰谷氨酰胺能抑制体外循环瓣膜置换术患者的炎症反应,保护肺泡毛细血管膜屏障功能,具有一定的肺保护作用。

Effect of ulinastatin combined with alanyl glutamine on lung protection in patients undergoing valve replacement operation through cardiopulmonary bypass

Objective To investigate the effect of ulinastatin combined with alanyl glutamine on alveolar bar-rier function in patients undergoing valve replacement operation through cardiopulmonary bypass(CPB). Methods Forty ASA Ⅱ or Ⅲ patients aged 40~60 years undergoing valve replacement operation through cardiopulmonary by-pass were randomly divided into 2 groups (20 cases in each group):ulinastatin group( group U) and ulinastatin com-bined with alanyl glutamine group( group UA) . After anesthesia induction,alanyl glutamine 0. 4 g/( kg·d) was infused in group UA,and the same volume of compound amino acid injection was given in group U,the drugs being infused for 24 h. Ulinastatin 20 000 U/kg was added to the priming solution in both groups. Three mL venous blood was taken for IL-6,TNF-αand SP-A detection accompanied by arterial blood gas analysis after anesthesia preoperatively (T0),before CPB ( T1 ) ,at 30 min after aorta unclamping( T2 ) ,at the end of operation( T3 ) ,at 5 h ( T4 ) and 24 h after operation ( T5 ) . The mechanical ventilation time was observed in ICU. Results Compared with T0 ,the levels of plasma TNF-αand IL-6 in both groups at T2 ~T5 increased (P<0. 05),and there were significant differences between the two groups (P<0. 05). Compared with T0,the SP-A level in both groups at T2 ~T5increased (P<0. 05),and there was signifi-cant difference between the two groups (P<0. 05). Compared with T0,the A-aDO2 and RI values in both groups in-creased at T2 ~T5(P<0. 05),and there were significant differences between the two groups (P<0. 05). The time of mechanical ventilation in group UA was significantly shorter than that of group U (P<0. 05). Conclusion Ulinastatin combined with alanyl glutamine can decrease the inflammatory response,protect alveolar barrier function,and thus pro-tecting the lung from injury.