不同剂量乌司他丁在兔常温体外循环中对凝血和纤溶系统的影响  

Effect of large dose of ulinastatin on coagulation-fibrinolysis system during normothermia cardiopul- monary bypass in rabbits

作　　者：昌克勤[1] 杨大烜[1] 王古岩[1] 薛庆华[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北京阜外心血管病医院麻醉科,100037

出　　处：《中国分子心脏病学杂志》2009年第5期310-313,共4页Molecular Cardiology of China

摘　　要：目的观察兔常温体外循环(extracorporeal circulation,ECC)前应用不同剂量乌司他丁对凝血和纤溶系统的影响。方法50只大耳白兔随机分成5组:乌司他丁1、2、3、4组(U1、U2、U3、U4组,每组n=10)和对照组(C组,n=10)。在ECC前分别给予U1、U2、U3、U4组乌司他丁1×10~4U·kg^(-1)、3×10~4U·kg^(-1)、5×10~4U·kg^(-1)、10×10~4U·kg^(-1);C组给予等量生理盐水。ECC常温转流30 min。分别记录ECC前、停机、停机后1 h、2 h和3 h的血流动力学指标,测定活化部分凝血激酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)和D二聚体(D-D)。结果ECC后各组APTT较ECC前显著延长(P<0.01),同时间点U4组APTT较C组延长更为明显,其它组APTT与C组无统计学差异。各组PT较ECC前也显著延长(P<0.01),U4组PT在停机3 h比C组延长(P<0.05),其它组PT与C组无显著差异。ECC后各组血浆FIB含量较ECC前显著降低(P<0.01),同时间点U4组血浆FIB含量显著高于C组(P<0.05)。ECC后各组血浆D-D浓度较ECC前显著升高(P<0.01),同时间点U4组D-D浓度明显低于C组(P<0.01)。结论ECC前应用10×10~4U·kg^(-1)乌司他丁可减少ECC中凝血因子的消耗,抑制纤溶系统的过度激活。Objective To investigate the effects of different doses of ulinastatin on coagulation- fibrinolysis system after extracorporeal circulation （ECC） by establishing the rabbit model of normothermia ECC. Methods Fifty rabbits are randomly assigned to control group （Group C,n = 10） and experiment group U1, U2, U3 and U4 （Group U1, U2, U3 and U4,n = 10 in each group）. The rabbits in Group U1, U2, U3 and I54 are administered ulinastatin 1 ×10^4U·kg^-1 , 3 ×10^4U·kg^-1 , 5 ×10^4U·kg^-1 and 10×10^4U·kg^-1 before ECC respectively, the rabbits in Group C are received same volume of saline at the same time. All rabbits are undergoing normothermia extracorporeal circulation for 30min. Hemodynamic parameters are recorded before ECC, at termination of ECC, 1 hour, 2 hour and 3 hour after ECC. APTT, PT, FIB and D-direct are determined at the above time point respectively. Results APTTs are prolonged after ECC in all Groups（P 〈0.01 ） ,APTTs after ECC in Group U4 are significantly longer than those in Group C respectively. PTs are prolonged after ECC in all Groups（P 〈0.01 ）. There is significant difference in PTs between Group U4 and Group C at 4h after ECC. The former is significantly shorter than the latter（ P 〈 0.05 ）. Levels of FIB in all Groups are decreased after ECC （ P 〈 0.01 ）, the levels of FIB after ECC in Group U4 are obviously higher than those in group C respectively （P 〈 0.05）. Concentrations of D-dimer in all Groups are increased after ECC （P 〈 0.01 ）, but concentrations of D-dimer after ECC in Group U4 are substantially lower than those in Group C respectively （P 〈 0.01 ）. Conclusion Administration of 10 ×10^4U·kg^-1 ulinastatin before ECC can reduce the consumption of blood coagulation factors during ECC, inhibit excessive activation of fibrinolysis system.

关 键 词：乌司他丁 体外循环 凝血功能 纤溶系统 

分 类 号：R654.1[医药卫生—外科学] R614[医药卫生—临床医学]