乌司他丁、立芷雪对体外循环心脏手术患者的血液保护作用  

THE EFFECT OF ULINASTATIN AND REPTILASE ON SAFEGUARD OF BLOOD IN PATIENTS UNDERGOING CARDIAC SURGERY UNDER EXTRACORPOREAL CIRCULATION

作　　者：谭瑞丹[1] 梁仁强[1] 陈海明[1] 

机构地区：[1]湛江中心人民医院,广东湛江524037

出　　处：《现代医院》2011年第6期26-28,共3页Modern Hospitals

摘　　要：目的探讨乌司他丁和立芷雪对体外循环心脏直视手术的血液保护的作用。方法选择180例体外循环心脏直视手术病人,随机分为乌司他丁组(U组)、立芷雪组(L组)和对照组(C组);每组各60例,乌司他丁30万U、立芷雪3 kU分别以生理盐水溶解稀释至20 ml,对照组为20 ml生理盐水,分别于麻醉后经静脉用微量泵30 min泵入。分别于麻醉后(T1)、体外循环转机30 min(T2)、手术结束时(T3)、手术结束后24 h(T4)4个时点自桡动脉取血,测定血红蛋白浓度、血小板计数、并记录术后胸腔引流量。结果三组血浆血红蛋白浓度、血小板计数于T2、T3、T4时明显下降,乌司他丁组和立芷雪组手术结束时血红蛋白浓度、血小板计数明显高于对照组,术后胸腔引流量也少于对照组。乌司他丁组和立芷雪组相比,各指标差异无显著性意义。结论在体外循环心脏直视手术期间血液纤溶系统亢进,血小板功能受损,乌司他丁可抑制纤溶系统的过度激活,保护了血小板的功能,具有和立芷雪相似的血液保护作用。Objective To investigate the blood protective effect of ulinastatin and reptilase during the process of open heart surgery performed under extracorporeal circulation.Methods 180 patients under open heart surgery with cardiopulmonary bypass were randomly divided into 3 groups;60 patients in each group,ulinastatin one（group U）,reptilase one（group L）and control（group C）.300 000 U of ulinastatin and 3ku of reptilase were diluted to 20 ml with normal saline respectively while group C was solely normal saline.All these drugs were injected within 30 mins separately through peripheral vein after anesthesia.Blood samples were collected immediately after anesthesia（T_1）.30 mins after extracorporeal circulation（T_2）,at the end of surgery（T_3）,and 24 h after surgery（T_4） for measuring hemoglobin concentration and blood platelet count.The thoracic drainage after operation was recorded as well.Results In all the 3 groups,the levels of plasma hemoglobin concentration and platelet count were significantly decreased at T_2,T_3,and T_4,at T_3,the levels of hemoglobin concentration and platelet count in group U and group L were obviously higher than those in group C while the levels of postoperative thoracic drainage was reverse.There is no significantly difference between group U and group L.Conclusion The excessive activation of blood fibrinolytic system causes impairment of platelet function during the operation,ulinastatin inhibits the activation,protects the platelet function and shares a similar protective effect on blood with reptilase.

关 键 词：乌司他丁 立芷雪 体外循环 血液保护 

分 类 号：R654.2[医药卫生—外科学]