乌司他丁对非体外循环冠状动脉旁路移植术患者心肌损伤的保护作用

目的 观察乌司他丁对非体外循环冠状动脉旁路移植术（OPCAB）患者围术期心肌损伤的影响。方法采取随机、双盲、对照的方法将24例OPCAB患者分为对照组（C组）和乌司他丁组（W组）,每组12例。W组：麻醉诱导后开始恒速静脉泵入6000U／kg的乌司他丁,30min输完,然后以1000U·kg^-1·h^-1的速度持续静脉泵入至手术结束。C组：给予同样容积的生理盐水。分别在切皮前（T1）、冠状动脉血管全部吻合结束后0．5h（T2）、术后2h（T3）、6h（T4）、18h（T5）采集患者血浆测定肌钙蛋白I（cTnI）浓度,并记录患者的临床资料。结果 C组和W组cTnⅠ值从术后2h至术后18h各时点均较切皮前显著升高（P〈0．01）。w组cTnⅠ值从血管吻合后0．5h至术后18h各时点均较C组显著降低（P〈0．05）。结论 乌司他丁可以降低OPCAB患者围术期cTnⅠ水平,对心肌损伤具有一定的保护作用。

Protection of ulinastatin against myocardial injury induced by off-pump coronary artery bypass graft surgery: report of 24 cases

OBJECTIVE: To investigate the protective effect of ulinastatin against myocardial injury induced by off-pump coronary artery bypass graft surgery (OPCAB). METHODS: Twenty-four patients undergoing OPCAB were randomly divided into 2 equal groups: ulinastatin group in which ulinastatin was infused intravenously, firstly at the concentration of 6000 U/kg dissolved in 50 ml normal saline for 30 min and then at the speed of 1000 U.kg(-1).h(-1) up to the end of operation, and control group that underwent infusion of normal saline of the same volume. Blood samples were collected before skin incision, 0.5 h after the completion of vascular anastomosis, and 2, 6, and 18 h after the operation to detect the plasma level of cardiac troponin 1 (cTn1). RESULTS: The cTn1 levels 2, 6, and 18 h after the operation of both groups were all significantly higher than those before skin incision (all P < 0.01). The cTn1 levels 0.5 h after the completion of vascular anastomosis, and 2, 6, and 18 h after the operation of the ulinastatin group were all significantly lower than those of the control group (all P < 0.01). CONCLUSION: Ulinastatin decreases the cTn1 level that increases peri-operatively, thus reducing the risk of myocardial injury in patients undergoing OPCAB.