乌司他丁对心脏瓣膜置换术患者围术期TNF-α和肺换气功能的影响  

Effects of ulinastatin on perioperative TNF-αlevel and pulmonary ventilation in patients receiving cardiac valve replacement therapy

作　　者：旷昕[1] 郭曲练[2] 

机构地区：[1]南华大学附一院麻醉科 [2]中南大学湘雅医院麻醉科,湖南长沙410008

出　　处：《中国现代医学杂志》2010年第4期552-555,共4页China Journal of Modern Medicine

基　　金：湖南省衡阳市科委资助项目(No:2005-023)

摘　　要：目的观察乌司他丁对心脏瓣膜置换术患者围术期TNF-α和肺换气功能的影响,以了解乌司他丁对体外循环所致的肺损伤是否具有保护作用。方法40例择期心脏瓣膜置换术患者,随机分为2组(每组20例)。乌司他丁组按1.2万U/kg体重计算乌司他丁用量,分别在麻醉诱导和心肺转流CPB开始时,按0.6万U/kg静注乌司他丁共两次;对照组用等量生理盐水替代,用法同乌司他丁组。分别于麻醉诱导前(T0),CPB10min(T1),CPB30min(T2),CPB结束后1h(T3),CPB结束后3h(T4),CPB结束后6h(T5)抽取桡动脉血,用ELISA法测定血浆TNF-α的浓度。同时测定T0、T3、T4、T5等时间点的肺死腔率(VD/VT)和血浆肺泡动脉血氧分压差(A-aDO2)。结果两组患者年龄、体重、性别比、体表面积、血红蛋白、红细胞压积、术前心肺功能、病种、总转流时间、主动脉阻断时间,手术类别和手术时间的变化均无统计学意义。T1～T5两组TNF-α均较T0明显升高,(P<0.05),均在T2达高峰。T3至T5两组VD/VT、A-aDO2均较T0明显升高(P<0.05),VD/VT在T3达高峰,A-aDO2在T4达高峰。U组T1至T5时TNF-α和T3至T5时VD/VT、A-aDO2均明显低于C组(P<0.05)。结论乌司他丁能明显减轻心脏瓣膜置换术患者围术期TNF-α的过度释放,减轻术后早期肺死腔率和肺泡动脉血氧分压差,对改善肺氧合保护肺功能有一定的作用。：【Objective】To observe the effects of ulinastatin （UTI） on the plasma level of TNF-αin patients receiving cardiac valve replacement therapy and to investigate its protective effects on lung injury. 【Methods】Totally 40 adult patients with ASA score Ⅱ-Ⅲ , who were scheduled for elective cardiac valvular replacement, were randomly allocated into two groups, ulinastatin group （group U, n =20） and control group （group C, n =20）. The patients in group U received a total of 12000 u/kg of ulinastatin. On introduction of anesthesia and before cardiopulmonary bypass （CPB） 6000 u/kg ulinastatin was given intravenously. The patients in group C received an equal amount of isotonic sodium chloride solution. Blood samples were taken from radial artery before introduction of anesthesia （T0）, 10 min after initiation of CPB （T1）, 30 min after initiation of CPB （T2）, 1 h （T3）, 3 h （T4） and 6 h （T5） after CPB for determination of plasma TNF-α concentration by ELISA. VD/VT and alveolar-arterial oxygen difference （AaDO2） were checked at T0, T3, T4, T5 after CPB.【Results】There was no significant difference between two groups in age, weight, sex, body surface area, operation time, CPB time, and aortic cross-clamping time. The concentrations of TNF-αsignificantly increased at T1-T5 compared to that at T0 in both groups （P 0.05） and reached peak at T2. And no difference between two groups at T0. The concentrations of VD/VT and AaDO2 at T3-T5 increased significantly compared to those at T0 （P 0.05） and VD/VT reached peak at T3 while AaDO2 at T4. The concentrations of TNF-α at T1-T5, VD/VT and AaDO2 at T3-T5 in group U were significantly lower than those in group C （P 0.05）. 【Conclusion】Ulinastatin suppresses the excessive release of TNF-α and protect the lungs from injury in patients undergoing cardiopulmonary bypass.

关 键 词：乌司他丁 心肺转流术 TNF-Α 肺损伤 

分 类 号：R563[医药卫生—呼吸系统]