乌司他丁对体外循环患者肺灌洗液中炎性因子和肺功能的影响  

Effects of Ulinastatin on Inflammatory Cytokins Levels in Bronchoalveolar Lavage Fluid and Pulmonary Function in Patients Undergoing Cardiopulmonary Bypass

作　　者：薛庆华[1] 昌克勤[1] 程卫平[1] 凌坚[2] 张艳婉[1] 李立环[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院麻醉科,北京市100037 [2]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院放射科,北京市100037

出　　处：《中国循环杂志》2006年第4期297-300,共4页Chinese Circulation Journal

摘　　要：目的:探讨丝氨酸蛋白酶抑制剂乌司他丁对体外循环下心脏直视手术患者肺灌洗液中炎性因子和肺功能的影响。方法:将30例拟行瓣膜置换术患者随机分为乌司他丁组和对照组,各15例。左心室射血分数<0．45、左心室舒张末直径>70 mm、心胸比率>0．7、血流动力学不稳定以及肝、肾功能障碍和急症手术的患者不选。乌司他丁组:在劈胸骨和升主动脉开放前分别给予乌司他丁0．6 KIU／kg;对照组:与乌司他丁组同时点只给予等量生理盐水。在术前和升主动脉开放后30分钟进行右肺中叶灌洗,采集肺灌洗液,用酶联免疫法测定中性粒细胞弹性蛋白酶和白细胞介素-8浓度,并在术前、升主动脉开放后30分钟、2小时和6小时记录呼气末二氧化碳(PETCO2)、采集桡动脉血行血气分析,计算肺功能指标:肺泡-动脉氧分压差[P(A-a)DO2]、氧合指数(PaO2／FiO2)和死腔率(VD／VT)。结果:①对照组肺灌洗液中白细胞介素-8浓度在升主动脉开放后30分钟升高,与术前比较差异有统计学意义(P< 0．05);乌司他丁组肺灌洗液中白细胞介素-8浓度在升主动脉开放后30分钟也较术前升高,但无显著差异(P>0．05),但乌司他丁组低于对照组同时点水平,差异有统计学意义(P<0．05);②对照组体外循环后各时点P(A-a)、DO2、VD／VT均较术前升高。P(A-a)DO2在升主动脉开放后30分钟、升主动脉开放后2小时升高与术前相比有统计学意义(P<0．05), VD／VT在升主动脉开放后30分钟升高达峰值(P<0．05);乌司他丁组在体外循环后各时点P(A-a)DO2、VD／VT也较术前升高,但无显著差异(P>0．05),在升主动脉开放后30分钟均低于对照组,差异有统计学意义(P<0．05);③对照组PaO2／FiO2体外循环后各时点与术前相比均降低,在升主动脉开放后30分钟降到最低值(P<0．05);乌司他丁组PaO2／FiO2在体外循环后各时点也降低,但无显著差异(P>0．05),在升主动脉开放�Objective ： To study the effects of ulinastatin on inflammatory cytokins levels in bronchoalveolar lavage fluid （BALF） and pulmonary function in patients undergoing cardiopulmonary bypass. Methods： Thirty patients for elective cardiac valve replacement were randomly divided into two groups. Ulinastatin group（ n = 15） was given ulinastatin 0.6 KIU/kg before cleaving of breastbone and releasing of aortic cross-clamping, respectively. The control group（ n =15 ） was given saline in addition to the ulinastatin administration. Patients with left ventricular ejection fraction 〈 0. 45, left ventricular end diastolic diameter 〉 70 mm, C/T 〉 0.7, and those whose hemodynamics was instability or with liver or kidney dysfunction were all excluded. Before procedures and 30 min after releasing of aortic cross-clamping, bronchoalveolar lavage fluid was collected from right middle lobe of the lung for measurements of neutrophil elastase and interleukin-8 concentration by enzyme-linked immunosorbent assay using an EIA kit according to the manufacturer＇s instruction. The end-expiratory CO2 pressure （PETCO2） was noted and blood samples were collected from radial artery for blood gas analysis before procedures and 30 min, 2, 6 hours after releasing of aortic cross-clamping in order to work out pulmonary function parameters ： arterial-alveolar difference of oxygen tension （P（A-a） DO2 ）, oxygenation index （ PaO2/FiO2 ） and physiologic dead space/tidal volume ratio VD/VT ）. Resuhs：①There was no significant difference in age,body surface area,cardiopulmonary bypass time and aortic cross-clamping time between the two groups. ②In control group, the concentration of interleukin-8 in bronchoalveolar lavage fluid was increased more obviously at 30 min after releasing of aortic cross-clamping than that before procedures （ P 〈 0. 05 ） ; In ulinastatin group, the concentration of interleukin-8 in bronchoalveolar lavage fluid was also increased at 30 min after releasing of aortic cross-

关 键 词：乌司他丁 心肺转流术 肺损伤 肺灌洗 

分 类 号：R54[医药卫生—心血管疾病]