乌司他丁和抑肽酶对心肌缺血再灌注损伤保护作用的对比研究  

Comparison of the protective effects of ulinastatin and aprotinin on ischemia-reperfusion injury

作　　者：赵琦峰[1] 张静[1] 胡型锑[1] 杜杰[1] 吴国伟[1] 费建斌[1] 

机构地区：[1]温州医学院附属第二医院,浙江温州325027

出　　处：《中国实用儿科杂志》2007年第10期748-751,共4页Chinese Journal of Practical Pediatrics

基　　金：浙江省温州市科技计划项目(Y2003A034)

摘　　要：目的评价乌司他丁和抑肽酶对小儿心内直视术围体外循环(CPB)期心肌缺血再灌注损伤的保护作用。方法按入选标准筛选2004-01—2005-08在温州医学院附属第二医院治疗的90例先天性心脏病患儿,随机双盲法分成6组:对照组(A组),小剂量乌司他丁组(10000U/kg,B组),大剂量乌司他丁组(20000U/kg,C组),小剂量抑肽酶组(75000kIU/kg,D组),大剂量抑肽酶组(150000kIU/kg,E组),小剂量乌司他丁+小剂量抑肽酶组(F组),每组15例。于CPB前(T1)、升主动脉开放后5min(T2)、CPB结束后30min(T3)、4h(T4)、24h(T5)5个时间点抽取桡动脉血,行血浆心肌肌钙蛋白I(cTnI)浓度及肌酸磷酸激酶(CK)、肌酸磷酸激酶同工酶(CK-MB)活性测定。术中定时监测激活全血凝固时间(ACT),红细胞压积(HCT);同时记录主动脉阻断(ACC)时间、总转流时间、心脏复跳情况及围术期血管活性药物使用情况。结果C、E、F组cTnI、CK、CK-MB明显低于A组(P<0.05);在T5点,B、D组cTnI明显低于A组(P<0.05)。与F组比较,A、B、D组cTnI、CK-MB,A组CK浓度明显升高(P<0.05)。B组与C组、D组与E组比较,cTnI、CK-MB浓度明显升高(P<0.05)。F组自动复跳率较A组增高,血管活性药物使用率较A组降低(P<0.05)。结论围CPB期单次使用乌司他丁和抑肽酶都能减轻心肌缺血再灌注损伤,药效呈剂量依赖性,但两者的保护作用差异无显著性;使用小剂量乌司他丁加小剂量抑肽酶减轻心肌损伤较为合理。Objective To investigate the protective effect of ulinastatin and aprotinin on myocardium against ischemiareperfusion injury in children undergoing open heart surgery with cardiopulmonary bypass（ CPB）. Methods Ninety patients were selected on standard, and randomly divided into six groups：control group （ groupA, n = 15 ） , small-dose ulinastatin group （ groupB, n = 15 ）, full-dose ulinastatin group （ groupC, n = 15 ）, small-dose aprotinin group （ groupD, n = 15 ） ,full-dose aprotinin group（ groupE, n = 15 ） ,small-dose ulinastatin ＋ small-dose aprotinin group （ groupF, n = 15 ）. Arterial blood samples were taken at preoperation（ T1 ） ,5 rain after release of the aortic cross-clamp（ T2 ）, and at 30min （T3 ）,2hours（ T4 ） ,24 hours（T5 ） after CPB termination for determination of plasma levels of cardiac troponin（ cTnI）, creatine phosphokinase （ CK） and creatine phosphokinase isoenzyme （ CK-MB）. Results The level of cTnI,CK,CK-MB was significantly lower in group C,E,F than group A （ P 〈0. 05） ,and at T5 cTnI was lower in group B,D than group A （ P 〈0. 05）. Compared with group F,cTnI,CK-MB in group A,B,D and CK in groupA were remarkably higher（ P 〈 0. 05 ）. The plasma cTnI,CK-MB concentrations in group B,D were significantly higher in comparison with group C,E respectively （ P 〈 0. 05 ）. The auto-rate jump was significantly increased in group F than in group A,while the usage of vasoactive agent was significantly reduced in group F than in group A. Conclusion Ulinastatin and aprotinin can effectively protect myocardium from ischemia-reperfusion injury in children during open heart surgery with CPB and the effects have positive correlation with dosage. There is no significant difference in the protective effects between ulinastatin and aprotinin. It is reasonable to use of small-dose ulinastatin and small-dose aprotinin to decrease myocardial injury.

关 键 词：乌司他丁 抑肽酶 体外循环 心肌保护 

分 类 号：R72[医药卫生—儿科]