乌司他丁联合丙氨酰谷氨酰胺对体外循环瓣膜置换术患者炎症反应及肺功能的影响  

Effects of Ulinastatin Combined with Alanyl Glutamine on Inflammatory Reactions and Pulmonary Functions of Patients with Cardiopulmonary Bypass Valve Replacement Surgery

作　　者：罗剑[1] 王振国[1] 陈泽富[1] 杨学永[1] 王韬渊[1] 

机构地区：[1]中国人民武装警察部队后勤学院附属医院心脏中心心外科,天津300162

出　　处：《现代生物医学进展》2017年第17期3295-3298,共4页Progress in Modern Biomedicine

基　　金：天津市自然科学基金项目(7142137)

摘　　要：目的:探讨体外循环(CPB)瓣膜置换术应用乌司他丁(ULi)联合丙氨酰谷氨酰胺(Ala-Gln)联合干预对患者机体炎症反应及肺功能的影响。方法:选取我院2013年6月~2016年11月收治并择期行CPB瓣膜置换术的54例患者,随机分为两组。对照组采用常规方法治疗,观察组采用丙氨酰谷氨酰胺(Ala-Gln)联合乌司他丁(ULi)。观察并比较两组患者围术期血清炎性因子及肺表面活性蛋白A(SP-A)水平、肺功能指标及机械通气时间。结果:与本组T_0时相比,两组在T_2、T_3、T_4、T_5血清IL-6、IL-8、T_NF-α及SP-A水平均显著升高(P<0.01);与对照组同期对比,观察组在T_2、T_3、T_4、T_5的血清炎性因子及SP-A水平更低(P<0.01)。与本组T_0时比较,两组在T_2、T_3、T_4、T_5的RI、A-a DO2值均显著上升(P<0.01);观察组在T_2、T_3、T_4、T_5各时点的RI、A-a DO2值均显著低于对照组同期(P<0.01)。与本组T_0时对比,两组在T_1时的Cst值均显著提高(P<0.01)。观察组机械通气时间显著低于对照组(P<0.01)。结论:CPB瓣膜置换术患者应用ULi联合Ala-Gln干预更能有效控制机体炎症反应,保护肺功能,值得临床推广应用。Objective： To investigate the effects ofulinastatin （ULi） combined with alanyl glutamine （Ala-Gln） on inflammatory reactions and pulmonary functions in patients with cardiopulmonary bypass （CPB） valve replacement surgery. Methods： 54 cases who had taken the CPB valve replacement surgery in our hospital from June 2013 to November 2016 were selected and randomly divided into two groups. The patients in the control group were treated with conventional method, while the patients in the observation group were treated with Ala-Gln and ULi. Then the serum levels of inflammatory factors and the pulmonary surfactant protein A （SP-A）, the lung function indexed and mechanical ventilation time between the two groups were observed and compared. Results： Compared with Te, the serum levels of IL-6, IL-8, TNF-α and SP-A in the two groups at T2, T3, T4 and T5 increased （P〈0.01）; Compared with the control group at the same time, the serum inflammatory factors and SP-A levels at T2, T3, T4 and T5 in the observation group were lower （P〈0.01）; Compared with To, the RI and A-aDO2 in the two groups at T2, T3, T4 and T5 increased （P〈0.01）; Compared with the control group at the same time, the RI and A-aDO2 values at T2, T3, 1＂4 and T5 in the observation group were lower （P〈0.01）; Compared with To, the Cst in the two groups at T, increased （P〈0.01）; The mechanical ventilation time in the observation group was significantly lower than that of the control group （P〈0.01）. Conclusion： ULi combined with Ala-Gln intervention on CPB valve replacement patients can effectively control the inflammatory reactions and protect the pulmonary functions, which is worthy of clinical application.

关 键 词：乌司他丁 丙氨酰谷氨酰胺 体外循环 瓣膜置换术 炎症反应 肺功能 

分 类 号：R542.5[医药卫生—心血管疾病] R654.2[医药卫生—内科学]