乌司他丁对婴幼儿体外循环心脏手术血小板功能的保护作用  

Protective effects of ulinastatin on thrombocytic function in infants and children undergoing open heart surgery under cardiopulmonary bypass

作　　者：施峥嵘[1] 姜子菲[1] 李晋德[2] 钮建宏[3] 马建平[3] 韩军[4] 恽志平[4] 吴浩清[5] 陆东明[6] 

机构地区：[1]南通大学附属常州市儿童医院心胸外科,213003 [2]南通大学附属常州市儿童医院心内科,213003 [3]南通大学附属常州市儿童医院体外循环科,213003 [4]南通大学附属常州市儿童医院麻醉科,213003 [5]常州市第一人民医院血液实验室 [6]南通大学附属常州市儿童医院检验科,213003

出　　处：《江苏医药》2008年第8期795-797,共3页Jiangsu Medical Journal

基　　金：常州市卫生局2004年科技发展计划项目

摘　　要：目的探讨乌司他丁在婴幼儿心肺转流(CPB)围术期对血小板功能的保护及止血作用。方法45例3岁以下房间隔缺损(ASD)或室间隔缺损(VSD)患儿随机分为三组,每组15例,分别在预充液中一次性加入抑肽酶(A组)、乌司他丁(U组)或未用药(C)组;选取4个时间点采静脉血测定血小板膜糖蛋白受体GPⅠb和GPⅡb/Ⅲa及血小板计数;记录术后纵隔引流量及输血量。结果GPⅠb、GPⅡb/Ⅲa组内及A、U组与C组之间比较有统计学意义(P<0.01),A组与U组间无统计学意义。血小板计数组间比较无统计学意义。A、U组术后纵隔引流量明显少于C组(P<0.05),U组与A组间无统计学意义。三组术后输血量无统计学意义。结论乌司他丁在婴幼儿先心病围术期通过保护GP而对血小板功能有部分保护作用,从而减轻术后非外科性出血,减少输血量,可取代抑肽酶作为婴幼儿先心病手术的血液保护用药。Objective To investigate the protective effects of ulinastatin on thrombocytic function in infants and children undergoing atrioseptopexy or surgical repair of ventricular septal defect（VSD） under cardiopulmonary bypass （CPB）. Methods Forty-five children （less than 3 years old） with atrial septal defect （ASD） or VSD undergoing open heart surgery under CPB were randomly divided into ulinastatin group（U）, aprotinin group（A） and control group（C） with 15 cases each. Ulinastatin （in group U） or aprotinin（in group A） was added into the prime solution before CPB,and nothing was used in group C. Blood samples were taken for determination of serum levels of GPⅠb and GP Ⅱ b/Ⅲ a. The platelet count, blood loss and blood transfusion after operation were documented. Results Compared with group C, aprotinin and ulinastatin effectively preserved GPⅠb and GP Ⅱb/Ⅲ a on the platelet membrane. Cumulative postoperative bleeding was significantly less in groupA and group U than that in group C. Conclusion Ulinastatin is as effective as aprotinin in stabilizing fibrinolytic system and preserving platelet function during CPB with less postoperative bleeding and transfusion.

关 键 词：乌司他丁 抑肽酶 心肺转流术 血小板 膜糖蛋白类 

分 类 号：R654[医药卫生—外科学]