乌司他丁对体外循环下心脏瓣膜置换术患者心功能及心肌细胞凋亡的影响  

Effects of Ulinastatin on Cardiac Function and Myocardial Apoptosis in Patients Undergoing Cardiac Valve Replacement with Cardiopulmonary Bypass

作　　者：刘金花[1] 邓莎[1] 庄海滨[1] 谢平[1] 

机构地区：[1]中国人民解放军第180医院麻醉科,福建泉州362000

出　　处：《南昌大学学报（医学版）》2015年第1期37-40,共4页Journal of Nanchang University：Medical Sciences

摘　　要：目的评价乌司他丁对体外循环（CPB）下心脏瓣膜置换术患者心功能及心肌细胞凋亡的影响。方法选择择期全身麻醉CPB下行心脏瓣膜置换术患者80例,NYHA心功能和ASA分级为Ⅱ—Ⅲ级。采用随机数字表法将80例患者分为乌司他丁组（U组,n=40）和生理盐水对照组（C组,n=40）。U组于主动脉开放前5min自主动脉根部灌注乌司他丁4 000~5 000U·kg^-1·min^-1（剂量10 000U·kg^-1）;C组给予等容量生理盐水。观察2组患者的心功能,记录多巴胺及肾上腺素用量,另于升主动脉开放后45min时取右心耳心肌组织,并检测Bax、Bcl-2蛋白的表达和心肌细胞凋亡情况,计算Bcl-2与Bax比值（Bcl-2/Bax）及凋亡指数（AI）。结果与C组比较,U组主动脉开放3~5min的心脏自动复跳率升高,心律失常评分、多巴胺及肾上腺素用量减少,Bax蛋白表达下调,Bcl-2蛋白表达上调,Bcl-2/Bax升高,AI降低（均P〈0.05）。结论乌司他丁通过促进Bcl-2/Bax通路减轻CPB下心脏瓣膜置换术患者心肌细胞的凋亡,同时患者心功能也得到改善。Objective To evaluate the effects of ulinastatin on cardiac function and myocardial apoptosis in patients undergoing cardiac valve replacement with cardiopulmonary bypass（CPB）.Methods Eighty NYHA and ASA Ⅱ-Ⅲ patients scheduled for cardiac valve replacement with CPB were randomly divided into two groups,with 40 patients in each group.The group U was given aortic root perfusion of 10 000U·kg^-1 ulinastatin（4 000-5 000U·kg^-1·minute-1）5minutes before aortic unclamping.The group C was given the same volume of normal saline.Cardiac function was observed in both groups,rocord the arnount of dopamine and adrenaline.In addition,myocardial tissues were obtained from right atrial appendage 45 minutes after aortic unclamping to determine the protein expression of Bax and Bcl-2and the myocardial apoptosis.The Bcl-2/Bax ratio and apoptotic index（AI）were calculated.Results Compared with group C,ulinastatin perfusion increased auto-resuscitation rate,decreased arrhythmia score and usage of dopamine and adrenaline,down-regulated Bax expression,up-regulated Bcl-2expression,elevated Bcl-2/Bax ratio,and reduced AI（P〈0.05）.Conclusion Ulinastatin can attenuate myocardial apoptosis and improve cardiac function through regulating Bcl-2and Bax expression in patients undergoing cardiac valve replacement with CPB.

关 键 词：乌司他丁 心肺转流术 心肌缺血再灌注损伤 细胞凋亡 BAX蛋白 BCL-2蛋白 

分 类 号：R654.2[医药卫生—外科学] R614[医药卫生—临床医学]