乌司他丁在体外循环心脏手术中对心肌的保护作用  

Effects of ulinastatin on myocardial protection in patients undergoing cardiac operation with cardiopulmonary bypass

作　　者：陈萍[1] 章晓华[1] 陈伟达[1] 罗智超[1] 周成斌[1] 彭东[1] 钟执文[1] 

机构地区：[1]广东省心血管病研究所心外科,广州510100

出　　处：《广东医学》2003年第5期481-483,共3页Guangdong Medical Journal

基　　金：广州市科委科研资助项目 (编号 :JB0 2 - 2 0 0 0 -X - 0 0 5- 0 1 - 0 3)

摘　　要：目的　探讨心脏手术体外循环 (CPB)中促炎细胞因子、心功酶、肌钙蛋白 (cTnI)的变化及应用乌司他丁(UTI)对心肌的保护作用。方法　 60例风湿性心脏病行瓣膜置换术的患者分为两组 ,UTI组 (U组 ) 3 2例 ,对照组 (C组 ) 2 8例。U组接受UTI 90万IU ,于麻醉后至CPB前缓慢静注 3 0万IU ,另 60万IU一次性加入预充液中 ;C组不接受UTI。分别于术前、术毕、术后第 1,3 ,7天测量血浆白细胞介素 (IL) -6、IL -8及肿瘤坏死因子 -α(TNF -α) ,乳酸脱氢酶 (LDH)、磷酸肌酸激酶同工酶 (CK -MB)、cTnI水平 ;记录心脏复跳及术后正性肌力药物的应用情况。结果　①炎性细胞因子术前各指标均无差异 ,术后显著升高 (P <0 0 5 ) ;IL -6,IL -8,TNF -α以术毕最高 ,此后逐渐下降 ;组间比较 ,术毕、术后第 1天U组IL -6,IL -8,TNF -α水平较C组低 (P <0 0 5 )。②CK -MB及cTnI术毕最高 ,LDH术后第 1天最高 ,此后逐渐下降 ;组间比较 ,术毕 3项指标U组均低于C组 (P <0 0 1～ 0 0 5 )。③术毕IL -6与LDH及cTnI,IL -8与CK -MB及LDH均成显著正相关 (P <0 0 0～ 0 0 5 )。④升主动脉开放后心脏自动复跳率U组为 81% ,C组为 79%。术后U组应用多巴胺的平均最大剂量少于C组 (P <0 0 5 ) ,U组肾上腺素的平均使用时间少于C组 (P <0 0Objective To investigate the perioperative alteration of proinflammatory cytokines, myocardial enzymes and cardiac troponin I(cTnI) under cardiopulmonary bypass and the effects of ulinastatin(UTI) on myocardial protection. Methods Sixty patients with rheumatic heart disease undergoing cardiac valve replacement were divided into two groups: UTI group(group U, n =32) received 30 000 IU UTI intravenously before cardiopulmonary bypass(CPB) and 60 000 IU in the priming solution; Control group (group C, n =28) did not receive UTI intravenously or in the priming. Blood samples were taken before skin incision(T1), at the end of operation(T2), and on the first(T3),the third(T4) and the seventh(T5) postoperative day for determination of plasma IL-6, IL-8, TNF-α, CK-MB, LDH and cTnI. Results ①IL-6,IL-8,TNF-α level at T2 and T3 in group U were lower than those in group C( P <0 05). ②CK-MB, LDH, cTnI level at T2 in group U were lower than those in group C( P <0 05). ③Correlation analysis shows IL-6 level at T2 correlated with LDH and cTnI. IL-8 level at T2 correlated with CK-MB and LDH( P =0 00～0 05). ④After cross-clamping releasing, the spontaneous return rate is 81% in group U and 79% in group C. The amount of inotropic drugs used postoperatively in group U is less than that in group C( P <0 05). Conclusion UTI is effective in reducing inflammatory response induced by CPB and can decrease myocardial injury.

关 键 词：乌司他丁 体外循环 心脏手术 心肌 保护作用 

分 类 号：R654.1[医药卫生—外科学]