不同剂量乌司他丁在婴幼儿体外循环中的肺保护作用  

Lung protection of different dosages of ulinastatin in infant heart operation under cardiopulmonary bypass

作　　者：张剑蔚[1] 陈煜[1] 朱明[1] 顾洪斌[1] 

机构地区：[1]上海第二医科大学新华医院上海儿童医学中心麻醉科,上海200127

出　　处：《上海第二医科大学学报》2004年第11期933-935,共3页Acta Universitatis Medicinalis Secondae Shanghai

摘　　要：目的研究乌司他丁 (UTI)在婴幼儿体外循环 (CPB)心脏直视手术中对炎性因子的影响及肺保护作用。方法 36例小儿先心病患儿随机分为 3组 ,每组 12例 ,U1组UTI 5 0 0 0U/kg、U2组UTI 10 0 0 0U/kg、对照组 (C组 )用等量生理盐水代替。分别在麻醉诱导后 (T1)、体外循环结束 (T2 )和术后 2h(T3 )等时点采集血样 ,检测血浆IL 6、IL 8、IL 10和TNF α。同时记录气道平均压、呼吸系统总顺应性 (Crs)、吸入氧浓度和动脉血气。结果与对照组相比 ,乌司他丁组体外循环中及术后 2hCrs明显升高 (P <0 .0 5 ) ,血浆IL 6、IL 8、TNF α明显降低 (P <0 .0 5 ) ,血浆IL 10明显升高 (P <0 .0 5 )。结论乌司他丁能有效地抑制体外循环心脏直视手术患儿围术期促炎细胞因子的释放 ,并上调抗炎细胞因子 ,因而能减轻体外循环引起的急性炎症反应 ,改善呼吸系统总顺应性 ;10 0 0 0U/kg剂量的乌司他丁较使用 5 0 0Objective To study the effects on inflammatory factors and lung protection of ulinastatin(UTI) in infants heart operation under cardiopulmonary bypass. Methods Thirty-six infants with congenital heart disease were randomly divided into 3 groups (n=12), U1 group: UTI 5 000 U/kg, U2 group: UTI 10 000 U/kg, control (C)group used equal normal saline. Blood samples were collected after the induction, on the cardiopulmonary bypass off time, 2 h after the end of operation, plasma IL-6, IL-8, IL-10 and TNF-α were detected. Mean airway pressure, respiratory system compliance, inhaled oxygen concentration, arterial blood gas were recorded at the same time. Results Plasma inflammatory mediums and cellular factors were increased apparently. Compared with group C, IL-6, IL-8, TNF-α were much lower (P<0.05) in U1 and U2 group, IL-10 was much higher (P<0.05) in groups U1 and U2. The decrease amount of U2 group in IL-6, IL-8, TNF- α and the increase amount in IL-10 more apparent than U1 group’s results. Crs during cardiopulmonary bypass in groups U1 and U2 were high while group C was reduced (P<0.05). Conclusion Ulinastatin can decrease the acute inflammatory response after CPB, it is able to facilitate the respiratory system’s acclimation. The dosages of 10 000 U/kg shows the better lung protection in infants heart operation under cardiopulmonary bypass than the dosages of 5 000 U/kg.

关 键 词：乌司他丁 婴幼儿 体外循环 肺保护 炎性反应 

分 类 号：R726.1[医药卫生—儿科]