乌司他丁对体外循环下心脏手术围术期炎症反应的影响  

Effect of Ulinastatin on Inflammatory Response in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass

作　　者：石佳[1] 李军[1] 张喆[1] 袁素[1] 陈芳[1] 何爱霞[1] 王古岩[1] 薛庆华[1] 肖文静[1] 李立环[1] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院麻醉科北京市,100037

出　　处：《中国循环杂志》2012年第4期305-308,共4页Chinese Circulation Journal

摘　　要：目的:探讨体外循环心脏手术中胰蛋白酶抑制剂乌司他丁对围术期体温、全身炎症反应综合征(SIRS)评分、外周血白细胞计数和中性粒细胞百分比的影响。方法:300例择期体外循环冠状动脉(冠脉)旁路移植术或瓣膜置换术患者,随机分为实验组与对照组各150例。实验组于麻醉诱导后、肝素化后以及鱼精蛋白中和后,分别给予乌司他丁各100万单位,对照组则给予等量生理盐水。2组分别于手术开始前、手术结束即刻、术后8 h、16 h、24 h、48 h和72 h记录体温(膀胱温)、评估SIRS评分、采集静脉血行血常规检查。结果:两组体温、SIRS评分和白细胞计数均在术后8小时达到高峰,随后逐渐下降,但至术后72 h仍显著高于手术前水平(P<0.01);中性粒细胞百分比自手术结束即刻显著上升,至术后72小时仍未有下降趋势,显著高于手术前水平(P<0.01)。在术后8 h、16 h、24 h、72 h四个时间点,实验组体温显著低于对照组(P<0.01);在术后8 h、16 h、24 h、48 h四个时间点,实验组SIRS评分、白细胞计数和中性粒细胞百分比显著低于对照组(P<0.01),差异有统计学意义。并发症发生率与死亡率在两组间没有统计学意义(P>0.05)。结论:乌司他丁可显著降低体外循环心脏手术围术期体温、SIRS评分、外周血白细胞计数和中性粒细胞百分比。Objective：To evaluate the effect of protease inhibitor ulinastatin on temperature, systemic inflammatory response syndrome （SIRS） score, the count of leukocytes and the percentage of nentrophils in patients of cardiac surgery with cardiopulmonary bypass at peri-operative period. Methods ： A total of 300 consecutive patients of elective cardiac surgery with cardiopulmonary bypass were randomly assigned into two groups as Ulinastatin group and Control group, n = 150 in each group. Ulinastatin group received ulinastatin 1,000,000 units at the time points of after induction, after heparinization and after protamine neutralization, and Control group received the same volume of normal saline at each same time point. The bladder temperature, SIRS score and routine blood work were examined at the time points of before incision,end of operation and 8,16,24 48 and 72 hours after operation respectively. Results ： The temperature, SIRS score and the count of leukocytes in both groups reached the peak at 8 hours after operation, and then starting to decline, those index were still higher than the baseline value at 72 hours after the operation,P〈0. 01. The per- centage of neutrophils increased immediately at the end of operation,it maintained high at 72 hours after the operation and obvi- ously higher than the baseline,P〈0.01. In Ulinastatin group,the temperature was lower at 8,16,24 and 72 hours after the opera- tion than those in Control group, P〈0. 01. At 8,16,24 and 48 hours after the operation, Ulinastatin group had the lower SIRS score, lower count of leukocytes and lower percentage of neutrophils than those in Control group, P〈0. 01. There was no real differ-ence in complication and mortality between two groups,P〉0. 05. Conclusion：Ulinastatin significantly reduced bladder temperature, SIRS score and leukocytes in patients undergoing cardiac surgery with cardiopulmonary bypass.

关 键 词：体外循环术 发热 全身炎症反应综合征 胰蛋白酶抑制剂 

分 类 号：R54[医药卫生—心血管疾病]