乌司他丁预处理对CPB下心脏瓣膜置换术患者鱼精蛋白诱发肺损伤的影响  

Effects of ulinastatin preconditioning on protamine-induced pulmonary injury in patients undergoing cardi- ac valve replacement under cardiopulmonary bypass

作　　者：王焰斌[1] 王小雷[1] 李刚[2] 王湘[2] 王毅[3] 程毅坚[1] 

机构地区：[1]广东省深圳市孙逸仙心血管医院麻醉科,518020 [2]广东省深圳市孙逸仙心血管医院心脏外科,518020 [3]广东省深圳市孙逸仙心血管医院检验科,518020

出　　处：《中华麻醉学杂志》2013年第5期525-529,共5页Chinese Journal of Anesthesiology

摘　　要：目的评价乌司他丁预处理对CPB下心脏瓣膜置换术患者鱼精蛋白诱发肺损伤的影响。方法择期CPB下行心脏瓣膜置换术患者60例，性别不限，年龄21-59岁，心功能分级Ⅱ或Ⅲ级，ASA分级Ⅱ或Ⅲ级。采用随机数字表法，将患者分为3组（n=20）：鱼精蛋白中心静脉给药对照组（c1组）、鱼精蛋白升主动脉给药对照组（c1组）和乌司他丁预处理组（U组）。U组于气管插管后至上腔静脉和下腔静脉阻断前10min经中心静脉输注乌司他丁20000U／kg。3组脱离CPB后10min时均经8min给予鱼精蛋白4mg／kg；C3组及u组经右颈内静脉给药，c2组经主动脉根部给药。分别于给予鱼精蛋白前5min和给予鱼精蛋白后15min时采集左心房和右心房血样，进行血小板计数（Plt）和中性粒细胞计数（PMN），测定血浆血栓烷B2（TXB2）、6-酮-前列腺素F1a（6-keto—PGF1a）的浓度；采集左心房血样，测定TNF—α、IL-1、IL-8、CD11b／CDl8、C3a、C5a、SOD和MDA的水平，进行血气分析，测定肺泡-动脉氧分压差（A—aDO2），计算呼吸指数（RI）和氧合指数（OI），并记录肺动脉压（PAP）。结果与右心房血比较，C1组给予鱼精蛋白后15min时左心房血P11和PMN降低，血浆TXB2浓度升高，C2组和u组血浆6-keto—PGF1a、SOD水平升高（P〈0．05）；与C1组比较，c2组和U组给予鱼精蛋白后15min时Plt、PMN、血浆6-keto-PGF1a浓度升高，血浆TXB2、TXB2／6-keto—PGF1a、TNF—α、IL-1、IL-8、C3a、C5a、MDA水平、PAP、A—aDO2和RI降低，CD11b／CD18表达下调，0I升高（P〈0．05）；U组和C2组间上述指标差异无统计学意义（P〉0．05）。结论乌司他丁预处理可抑制CPB下心脏瓣膜置换术患者鱼精蛋白诱发肺损伤，其作用与经主动脉途径给予鱼精蛋白相似。Objective To evaluate the effects of ulinastatin preconditioning on protamine-induced pulmo- nary injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass （CPB）. Methods Six- ty NYHA class U or m and ASA physical status 1I or I]I patients of sexes, aged 21-59 yr, scheduled for elective cardiac valve replacement under CPB, were randomly divided into 3 groups （ n = 20 each） ： group control one pro- tamine given via central vein （ group C~ ） ; group control two protamine given via ascending aorta （ group C2 ） ; group ulinastatin preconditioning （group U） ~ Heparin was neutralized with protamine after termination of CPB. Ulinastatin 20 000 U/kg was infused via the central vein at a rate of 500-1000 U·kg-1·min-1 starting from the time point after tracheal intubation until 10 min before cross-clamping of superior vena cava and inferior vena cava in group U. At 10 min after termination of CPB, protamine 4 mg/kg was infused over 8 min via the right internal jug- ular vein in groups Cj and U, or via the aortic root in group C2 ~ Blood samples were obtained from the left atrium and right atrium at 5 min before neutralization of heparin with protamine （T1 ） and 15 min after neutralization of he- parin with protamine （T2） for determination of polymorphonuclear leukocyte （PMN） and platelet （Ph） counts, and plasma concentrations of thromboxane B2 （TXB2） and 6-keto-prostaglandin F1a （6-keto-PGF1a）. Blood samples were obtained from the left atrium at Ti and T2 for determination of the levels of TNF-a, IL-1, IL-8, CDllb/CD18, C3a, C5a, and malondialdehyde （MDA） and superoxide dismutase （SOD） activity and for blood gas analysis. Alveolar-arterial oxygen gradiant （A-aDO2）, respiratory index （RI） and oxygenation index （OI） were calculated. Pulmonary arterial pressure （PAP） was recorded. Results Pit and PMN counts in the blood obtained from the left atrium were significantly lower, and plasma TXB2 concentrations in the blood obtained f

关 键 词：胰蛋白酶抑制剂 呼吸窘迫综合征 成人 鱼精蛋白 心肺转流术 心脏瓣膜假体植入 预处理 

分 类 号：R654.2[医药卫生—外科学]