乌司他丁对深低温停循环主动脉手术患者肾缺血再灌注损伤的影响  

Effects of ulinastatin on renal ischemia-reperfusion injury in patients undergoing operation on aorta with deep hypothermic circulatory arrest

作　　者：王焰斌[1] 王小雷[1] 李刚[2] 翟宇佳[1] 程毅坚[1] 王毅[3] 杨建安[2] 

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》2014年第3期266-269,共4页Chinese Journal of Anesthesiology

摘　　要：目的：评价乌司他丁对深低温停循环（DHCA ）主动脉手术患者肾缺血再灌注损伤的影响。方法择期行DHCA主动脉手术患者30例，年龄30～50岁，心功能分级Ⅱ或Ⅲ级，ASA分级Ⅲ或Ⅳ级，采用随机数字表法，将其分为2组（ n＝15）：对照组（C组）和乌司他丁组（U组）。U组于气管插管后即刻～升主动脉阻断前10 min经中心静脉输注乌司他丁500～1000 U·kg-1·min-1（剂量20000 U/kg ）；C组给予等容量生理盐水。于DHCA前5 min （T1）和DHCA结束后15 min （T2）采集体外循环中血样，进行中性粒细胞（PMN ）计数，测定血浆细胞间黏附分子-1、肿瘤坏死因子-α、白细胞介素-6、白细胞介素-8、白细胞介素-10、丙二醛、髓过氧化物酶、心房钠尿肽、胱抑素C和肌酐的水平。结果与C组比较，U组PMN计数、血浆细胞间黏附分子-1、肿瘤坏死因子-α、白细胞介素-6、白细胞介素-8、丙二醛、髓过氧化物酶、胱抑素C和肌酐的水平降低，血浆白细胞介素-10及心房钠尿肽的浓度升高（ P＜0.05）。结论乌司他丁可减轻DHCA主动脉手术患者肾缺血再灌注损伤，其机制与抑制炎性反应有关。Objective To evaluate the effects of ulinastatin on renal ischemia-reperfusion injury in patients undergoing operation on aorta with deep hypothermic circulatory arrest （DHCA ） .Methods Thirty patients ,aged 30-50 yr ,of ASA physical status Ⅲ or Ⅳ （NYHA Ⅱ or Ⅲ） ,scheduled for elective operation on aorta with DHCA ,were randomly divided into 2 groups （ n=15 each） using a random number table ：control group （group C ） and ulinastatin group （group U ） .In group U ,ulinastatin 20 000 U/kg was infused via the central vein at 500-1 000 U·kg-1 ·min-1 from the time immediately after tracheal intubation until 10 min before ascending aortic cross-clamping .In group C ,the equal volume of normal saline was infused instead of ulinastatin .At 5 min before the beginning of DHCA （T1 ） and 15 min after the end of DHCA （T2 ） ,blood samples were taken from the extracorporeal circulation for determination of polymorphonuclear leukocyte counts , and plasma levels of intercellular adhesion molecule-1 , tumor necrosis factor-α, iterleukin-6 （IL-6 ） IL-8 , IL-10 , malondialdehyde , myeloperoxidase ,atrial natriuretic peptide ,cystatin C ,and creatinine .Results The polymorphonuclear leukocyte counts and plasma levels of intercellular adhesion molecule-1 , tumor necrosis factor-α, IL-6 , IL-8 , malondialdehyde , myeloperoxidase , cystatin C , and creatinine were significantly lower , and the plasma concentrations of IL-10 and atrial natriuretic peptide were higher in group U than in group C （ P〈 0.05 ） .＆nbsp;Conclusion Ulinastatin can attenuate renal ischemia-reperfusion injury in patients undergoing operation on aorta with DHCA and inhibition of inflammatory responses is involved in the mechanism .

关 键 词：胰蛋白酶抑制剂 低温 人工 心肺转流术 再灌注损伤 肾 

分 类 号：R614[医药卫生—麻醉学]