乌司他丁对体外循环下心脏瓣膜置换术病人炎症细胞因子、心肺功能和疾病预后的影响  

Effects of Ulinastatin on Inflammatory Cytokines,Cardiopulmonary Function,and Prognosis in Patients Undergoing Cardiopulmonary Bypass Valve Replacement

作　　者：景仕银 史加海[2] JING Shiyin;SHI Jiahai(Hai′an Hospital Affiliated to Nantong University,Hai′an 226600,Jiangsu,China;Affiliated Hospital of Nantong University,Nantong 226001,Jiangsu,China)

机构地区：[1]南通大学附属海安医院,江苏海安226600 [2]南通大学附属医院,江苏南通226001

出　　处：《中西医结合心脑血管病杂志》2020年第17期2850-2853,共4页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：2018年南通市市级科技计划项目(No.MS32015027)。

摘　　要：目的探讨乌司他丁对体外循环(CPB)下心脏瓣膜置换术(HVR)病人围术期炎性因子、心肺功能和预后的影响。方法选取2016年1月—2019年9月在CPB下行HVR的病人68例,随机分成两组,对照组给予常规治疗,观察组在对照组基础上加用乌司他丁治疗。观察两组炎症细胞因子水平和心肺功能指标变化以及预后相关指标。结果麻醉诱导前(T0)两组血清超敏C反应蛋白(hs-CRP)、基质金属蛋白酶-9(MMP-9)、丙二醛(MDA)、肺表面活性蛋白A(SP-A)等炎症细胞因子水平,以及超敏肌钙蛋白T(hs-TnT)、左室射血分数(LVEF)、肺泡-动脉氧分压差(A-aDO2)和氧合指数(OI)等心肺功能指标比较,差异均无统计学意义(P>0.05);术后5 h(T1)、术后第2天(T2)和术后第5天(T3)时,两组hs-CRP、MMP-9、MDA、SP-A、A-aDO2、hs-TnT和LVEF水平均较T0时升高(P<0.05),OI均较T0时下降(P<0.05),且观察组改善程度优于对照组(P<0.05)。观察组机械通气时间和入住重症监护室天数明显短于对照组(P<0.05),围术期低心排血量综合征、急性肾损伤和医院感染发生率均低于对照组,但差异无统计学意义(P>0.05)。结论对CPB行HVR病人围术期采用乌司他丁辅助治疗,能有效抑制机体炎症反应,改善心、肺、肾功能,促进术后康复进程,改善疾病预后。Objective To investigate the effect of ulinastatin on inflammatory factors,cardiopulmonary function and therapeutic effect in patients undergoing cardiopulmonary bypass(CPB)heart valve replacement(HVR).Methods Sixty-eight HVR patients receiving CPB were randomly divided into two groups.The patients in control group were given conventional treatment,and the patients in experimental group were treated with ulinastatin on the basis of control group.The changes of inflammatory cytokines,cardiopulmonary function,and the related indicators of efficacy were observed.Results Before anesthesia induction(T0),the levels of high-sensitivity C-reactive protein(hs-CRP),matrix metalloproteinase-9(MMP-9),malondialdehyde(MDA),surfactant protein A(SP-A),as well as cardiopulmonary function indicators such as hypersensitive troponin T(hs-TnT),left ventricular ejection fraction(LVEF),alveolar artenal oxygen partial pressure difference(A-aDO2),and oxygenation index(OI)were no significantly different between two groups(P>0.05).The levels of hs-CRP,MMP-9,MDA,SP-A,A-aDO2,hs-TnT,and LVEF levels increased(P<0.05),while OI decreased(P<0.05)in two groups at 5 h(T1),2 d(T2),and 5 d(T3)after surgery,the data in experimental group were significantly improved than that in control group(P<0.05).The duration of mechanical ventilation and ICU stay in experimental group were significantly shorter than those in control group,and the rates of perioperative low cardiac output syndrome(LCOS),acute kidney injury(AKI)and nosocomial infection in experimental group were lower than those in control group(P<0.05).Conclusion Ulinastatin can effectively inhibit the inflammatory response,improve cardiopulmonary and renal functions,promote postoperative recovery process,and improve the prognosis in patients undergoing CPB HVR.

关 键 词：乌司他丁 体外循环 心脏瓣膜置换术 炎症细胞因子 心肺功能 超敏C反应蛋白 左室射血分数 

分 类 号：R654.2[医药卫生—外科学] R256.2[医药卫生—临床医学]