不同途径注入乌司他丁对心内直视术心肌保护的比较  

Protection of ulinastatin by different ways of administration on ischemia-induced myocardiac injury during open heart surgery

作　　者：应俊[1] 徐国海[1] 胡衍辉[1] 朱晓红[1] 罗振中[1] 

机构地区：[1]南昌大学第二附属医院麻醉科,南昌市330006

出　　处：《临床麻醉学杂志》2011年第9期854-857,共4页Journal of Clinical Anesthesiology

摘　　要：目的观察乌司他丁经不同途径注入对心内直视手术围心肺转流（CPB）期心肌缺血-再灌注损伤的影响。方法选择45例心功能Ⅱ或Ⅲ级需在CPB下行单纯人工二尖瓣置换术的风湿性瓣膜病患者，随机分为三组，每组15例，A组：乌司他丁以12000U／kg半量加在停跳液500m1中，另半量加入预充液中；B组：麻醉诱导后锯胸骨前经颈内静脉缓慢推注乌司他丁12000U／kg的半量，另半量加入预充液中；C组：用等量的生理盐水。于切皮前（]r0）、CPB30min（T1）、主动脉开放后1h（T2）、6h（T3）、24h（T4）抽取静脉血测定血浆中肌酸磷酸激酶同工酶（CK—MB）、中性粒细胞弹性蛋白酶（NE）、血浆白细胞介素6（IL-6）、白细胞介素10（IL-10）、血浆肿瘤坏死因子α（TNF-α）。结果与T0时比较，T1～T1时三组cK—MB、NE、IL-6、IL-10及TNF-α均明显升高（P〈0．05）；与C组比较，T2～T4时A、B组CK—MB、NE、IL-6、TNF-α均明显降低及IL-10明显升高（P〈0．05）；与B组比较，T3、T4时A组CK—MB、NE、IL6、TNF-α均明显降低及IL-10明显升高（P〈0．05）。结论乌司他丁对CPB下行心内直视手术对心肌缺血一再灌注损伤具有保护作用，抑制炎症因子的释放，乌司他丁加入停跳液的保护作用优于传统的静脉给药效果。Objective To investigate the effects of ulinastatin in different ways on myocardiac injury induced by ischemia-reperfusion in patient undergoing open heart surgery. Methods Forty-five patients, undergoing simple mitral valve replacement under cardiopulmonary bypass, were randomly divided into three groups. In group A（n： 15）, the patients received ulinastitin 12 000 U/kg, half dose of which was added into the cardioplegia, and another half was added into the primary solution; In group B（n= 15）, the patients received ulinastitin 12 000 U/kg, half dose of which was gived before CPB, and another half was added into the primary solution. In group C （n= 15）, the control group, the patients was used normal saline instead of ulinastitin. Blood samples were taken before operation （To）, 30rain after CBP（T1 ）, 1 h（T2 ）, 6 h（T3 ）, 24 h（T4 ） after aortic unclamping for determination of plasma concentrations of CM-KI3, NE, IL-6, IL-10 and TNF-α activity. Results The plasma concentrations of CK-MB, NE, IL-6, IL-10 and TNFα were significantly higher in three groups at T2 to T4 than To （P 〈 0.05）; The plasma concentrations of CKMB, NE, IL-6 and TNF-αwere significantly lower, while IL-10 was higher in Group A and Group B at T2 to T4 than Group C（P〈 0. 05）. The plasma concentrations of CK-MB,NE, IL-6 and TNF-α were significantly lower and IL-10 was higher at T3 to T4 in Group A than Group B（P〈0.05）. Conclusion Ulinastitin has myocardial protection effect on patients undergoing open heart surgery with cardiopulmonary bypass, the inhibition of the inflammatory response may be one of its possible mechanisms; the protection effect of ulinastitin added into cardioplegia and primed fluid is better.

关 键 词：乌司他丁 停跳液 心肌缺血-再灌注损伤 心肌保护 心肺转流 

分 类 号：R654.2[医药卫生—外科学]