乌司他丁后处理对心脏瓣膜置换患者心功能的影响  

The protective effects of ulinastatin on cardiac function in heart valve replacements

作　　者：王焰斌[1] 杨建安[2] 王小雷[1] 姚平[3] 黄志勇[1] 翟宇佳[1] 程毅坚[1] 叶晓青[1] 李刚[2] 杨晓涵[2] 郭建洲[2] 

机构地区：[1]深圳市孙逸仙心血管医院麻醉科,518020 [2]深圳市孙逸仙心血管医院外科,518020 [3]广东省深圳市人民医院院感染科

出　　处：《中华胸心血管外科杂志》2011年第11期662-667,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：2010年深圳市科技计划项目（201002118）和2010年天普研究基金项目（01200903）资助

摘　　要：目的评价乌司他丁（ulinastatin，UTI）后处理对心脏瓣膜置换患者心功能的影响。方法2010年4月至2011年6月行心脏瓣膜置换术患者120例，随机均分为4组：U1组（预处理组），UTI20000U／kg，于麻醉后至升主动脉阻断前10min自中心静脉输入；U2组（后处理组），UTl10000／kg，于丌主动脉开放前5min自主动脉根部灌人；U3组（联合处婵组），U1、U2组方法联用；C组（对照组），不用UTI。对比分析4组患哲的心功能情况。结果（1）U1、U2、U3组主动脉开放3～5min心脏自动复跳率（70％、73％、90％）高于C组（33％）；（2）U1、U2组再灌注心律失常评分、心电图ST—T段改变、血管活性药物的使用刹量和时间及血清MDA、H—FABP、IMA、CK—MB的浓度均低于C组而高于U3组（P〈0．05），血清SOD活性高于C组而低于U3组（P〈0．05），而U1、U2两组间上述指标均无显著差异（P〉0．05）；（3）光镜下C组心肌组织呈凝同性坏死灶，示无结构的嗜酸性染色区；U3组心肌细胞损伤较小，细胞质、核染色均匀，边界清。结论UTI后处理通过抑制氧自由基减轻再灌注心律失常，产生心肌保护作用，从而改善心功能，和预处理保护作用相当，联合处理产生协同保护作用。Objective To evaluate the effects of ulinastatin on cardiac function in heart valve replacement patients with curdio-pubnnnal7 bypass （CPB）. Methods 120 patients received valve replacements were divided into 4 groups at random. Group U1 , preconditioning group：ulinastatin parenteral solution （20 000 U/kg） was injected into the central veins for 10 min before the ascending aorta was clamped. Group U2, postconditioning group： ulinastatin （10 000 U/kg） was injected into the aortic root for 5 min before the aortic clamp was opened. Group U3, combined the treahnents of group UI and group U2. Group C was served as control without using ulinastatin. The ST-T of ECG at different 8 time points was recorded from preanesthesia to the end of operation. The dosage of vasoaetive agents in the 4 groups was reorded after the aootie clamp was opened. Blood samples were taken from the radial adery at 4 time points during 10 min before the ascending aorta was elamed to the end of operatiun for determining the serum eoneentration of H-FABP, IMA, CK-MB, MDA and SOD. The changes in myoeardium were examined by microscope. Results The automatic rebeating rate of heart in group UI, group U2, and group U3 were 70% , 73% and 90% respeetively, which were all higher than grnup C （33%） after the aortie clamp was opened in 3 -5 min. The scores of reperlusion arrbythmia, change of ST segments in ECG （ elevation or depression） , the dosage of vasoaetive drugs （ dopamine and adrenaline） and their using time, the concentration of MDA , H-FABP, IMA and CK-MB in group UI ant] group U2 were 〈 tban those of group C （ P 〈 0.05 ） , but was 〉 than those of group U3 （ P 〈 0.05 ）. The activity of SOD in group UI and group U2 were 〉 than those of group C （P 〈0.05）, hut was 〈 than those of group U3 （P 〈0.05）. There were no sig- ni[icant diB^rences between group U1 and group U2（ P 〉 0.05 ）. The myoeardium in group C had focal coagulative necrosis. The damage of myocardium in group U3 was minor,

关 键 词：人工瓣膜假体植入 心肌冉灌注损伤 心肺转流术 乌司他丁 

分 类 号：R654.2[医药卫生—外科学]