非体外循环心脏手术凝血酶和血小板的激活及乌司他丁的影响  

Effect of ulinastatin on thrombin and platelet activation in the patients during off-pump coronary artery bypass graft surgery

作　　者：王古岩[1] 吉冰洋[2] 刘宁宁[3] 昌克勤[1] 王越夫[1] 何爱霞[1] 李立环[1] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院麻醉科,北京100037 [2]首都医科大学附属安贞医院体外循环科 [3]首都医科大学附属安贞医院心外科

出　　处：《中国体外循环杂志》2010年第2期100-102,121,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的观察非体外循环冠状动脉旁路移植术(OPCABG)患者围术期凝血酶和血小板的激活情况及乌司他丁对此的影响。方法采取随机、双盲、对照的方法将40例OPCABG患者分为对照组(C组)和乌司他丁组(U组),每组20例。U组:麻醉诱导后开始恒速静脉泵入6 000 U/kg的乌司他丁,30 min内输完,然后以1 000 U/(kg.h)的速度持续静脉泵入至手术结束。C组:给予相同容积的生理盐水。分别在切皮前(T1)、术后即刻(T2)、术后2 h(T3)、6 h(T4)、术后18 h(T5)测定血小板α颗粒膜蛋白(GMP-140)和尿纤维蛋白肽(uFPA)浓度,并记录患者的术后24 h胸液量等临床资料。结果与T1比较,两组在T2和T3时点uFPA浓度和在T3、T4和T5时点GMP-140浓度均显著升高(P<0.05);组间比较差异均无统计学意义(P>0.05)。结论 OPCABG患者围术期存在凝血酶和血小板激活,乌司他丁对此无明确保护作用。OBJECTIVE To investigate the effects of ulinastatin on perioperative thrombin and platelet activation in the patients undergoing off-pump coronary artery bypass graft surgery（OPCABG）.METHODS Forty low risk patients undergoing OPCABG were divided in a double-blind and randomized fashion into 2 groups（n=20 each）： control group（C） and ulinastatin group（U）.Anesthesia was induced with midazolam 0.1mg/kg,fentanyl 10-20μg/kg and pancuronium 0.1 mg/kg,and maintained with 1%-2% isoflurane and intermittent IV boluses of fentanyl and pancuronium.Ulinastatin 6000 U/kg in 50 ml of normal saline was infused intravenously over 30 min after induction of anesthesia followed by continuous infusion of ulinastatin at 1000 U/（kg·h） until the end of the operation.In group C,the equal volume of normal saline was infused instead of ulinastatin.Venous blood and urine samples were taken before operation（T1）,at the end of operation（T2）,and 2 h（T3）,6 h（T4）,and 18 h（T5） after the operation for determination of plasma α-granule membrane protein-140（GMP-140） and urine fibrinopeptide A（uFPA） concentration.RESULTS Plasma concentration of GMP-140 at T3-5 and uFPA concentration at T2,3 were significantly increased compared with baseline value at T1 in both groups,but there was no significant difference between 2 groups.CONCLUSION Current data suggested that Ulinastatin cannot inhibit the thrombin and platelet activating during and after operation in the patients undergoing OPCABG.

关 键 词：非体外循环 冠状动脉旁路移植术 胰蛋白酶抑制剂 纤维蛋白肽A 血小板Α颗粒膜蛋白 

分 类 号：R654.1[医药卫生—外科学]