乌司他丁对二尖瓣置换术患者肺和肾脏的保护作用  

The protective effect of ulinastatin on lung and kidney for patients with mitral valve replacement

作　　者：李倩[1] 刘钰[1] 刘苏[1] 于丁[1] 陈子英[1] 

机构地区：[1]河北医科大学第二医院心脏外科,石家庄050000

出　　处：《中华实验外科杂志》2012年第6期1184-1186,共3页Chinese Journal of Experimental Surgery

摘　　要：目的观察乌司他丁对二尖瓣置换术患者肺和肾脏的保护作用。方法60例二尖瓣置换术患者，随机分为实验组（30例，乌司他丁组，10000IU／kg）和对照组（30例，生理盐水组）。在麻醉诱导后（T1）、开放升主动脉后不同时点（T2～T9）分别监测动脉血气指标和肾功能进行分析。结果开放升主动脉后，对照组的血氧分压（PaO2）均低于实验组（P〈0．05）；对照组呼吸指数上升（P〈0．01），且于3个时点明显高于实验组（0．560±0．079比0．485±0．094，0．592±0．078比0．475±0．085，0．537±0．078比0．430±0．083，P〈0．05）。对照组氧合指数（PaO2／FiO2）均低于术前水平（P〈0．01，最低达173．1±23．7），而且明显低于实验组（P〈0．01，173．1±23．7比278．9±22．4）。实验组血浆乳酸（Lac）均明显低于对照组（P〈0．05）。术后对照组尿素氮（BUN）、肌酐（Cr）呈上升趋势（P〈0．05），而实验组与术前比较差异无统计学意义（P〉0．05）。结论在二尖瓣置换术中应用乌司他丁对患者的肺、肾功能具有显著的保护作用，还可以降低血乳酸浓度、改善乳酸代谢。Objective To explore the protective effect of Ulinastatin on lung and kidney for patients with mitral valve replacement （MVR）. Methods 60 patients who received MVR surgery were randomly divided into two groups ： treatment group （T group, 30 cases, ulinastatin, 10 000 IU/kg） and control group （C group, 30 cases, saline）. The data about arterial blood gas analysis and renal function were recorded and analyzed after induction of anesthesia （ T1 ） and at different time points after releasing of aortic cross-clamping （T2-T9）. Results After releasing of aortic cross-clamping, PaO2 in C group were significantly lower than in T group （ P 〈 0.05 ）. RI in C group were significantly increased （ P 〈 0.01 ） , while there were no significant changes in T group （ P 〉 0. 05 ） ; RI in C group were significantly higher than in T group （0. 560 ± 0. 079 vs 0. 485 ± 0. 094, 0. 592 ± 0. 078 vs 0. 475 ± 0. 085, 0. 537 ± 0. 078 vs 0. 430 ± 0. 083, P 〈 0.05 ）. The level of PaO2/FiO2 C group were significantly lower than the preoperative level （P 〈0. 01 ）, which were significantly lower than in T group （P 〈0.01 ） ; Lac in T group were significantly lower than C group （ P 〈 0. 05 ）. Compared with preoperative, blood urea nitrogen （BUN） and creatinine （Cr） were higher in C group （P 〈 0.05 ）, but T group, there were no significantly difference （P 〉 0.05 ）. Conclusion The experiment proved that the application of ulinastatin in mitral valve replacement has a significant protective effect on lung and renal functions, it also can lower blood lactate concentration, improved lactate metabolism.

关 键 词：体外循环 二尖瓣置换术 乌司他丁 氧合指数 呼吸指数 肾功能 

分 类 号：R65[医药卫生—外科学] R614[医药卫生—临床医学]