乌司他丁在体外循环心内直视手术期间对心肌再灌注损伤的保护作用  

Myocardial protective effect of ulinastatin against ischemia/reperfusion injury during open heart surgery with cardiopulmonary bypass

作　　者：任同悦[1] 杨晓伟[2] 马越[3] 王方[1] 强万党[1] 

机构地区：[1]天津市第四中心医院麻醉科,300140 [2]天津市胸科医院麻醉科 [3]天津医科大学第三附属医院麻醉科

出　　处：《中华医学杂志》2003年第16期1391-1393,共3页National Medical Journal of China

摘　　要：目的　观察乌司他丁对先天性心脏病心内直视手术围体外循环期 (CPB)心肌再灌注损伤的防护作用。方法　 2 0例房间隔缺损或室间隔缺损修补术患者 ,随机分为对照组 (C组 )与乌司他丁组 (U组 ) ,每组 10例。于体外转流前 (T1)、开放主动脉即刻 (T2 )、开放主动脉 30min (T3 )、停止CPB4h (T4)和 2 4h(T5)抽取动脉血 ,测定血浆CK MB、CK活性及心肌肌钙蛋白I(cTnI)浓度。记录CPB转机时间、主动脉阻断时间、手术时间、围CPB期间心血管活性药物的使用情况、心脏复跳情况以及术后 2 4h引流量。结果　两组患者术前血浆cTnI浓度及CK、CK MB活性均在正常范围内 ,组间比较差异无显著意义。C组血浆cTnI浓度在T3 、T4和T5时间点显著升高 (P <0 0 1) ,于T4时点达峰值 ,T5时点开始下降。U组血浆cTnI浓度在T3 、T4时点显著升高 (P <0 0 1) ,于T5时间点已下降至正常水平。在T3 ～T5时间点U组cTnI水平明显低于C组 (P <0 0 1)。C组与U组血浆CK和CK MB活性在T2 ～T5时点都显著升高 (P <0 0 1) ,T2 ～T4时点两组比较差异无显著意义 ,至T5时点U组显著低于C组(P <0 0 5 ) ,U组自动复跳率多于C组 (P <0 0 5 )。术后 2 4h引流量C组明显多于U组 (P <0 0 5 )。结论　围CPB期间分两次使用乌司他丁 1 2万U/kg 。Objective To investigate the protective effect of ulinastatin on myocardium against ischemia-reperfusion injury in open heart surgery with cardiopulmonary bypass (CPB). Methods Twenty ASA Ⅰ-Ⅱ patients undergoing atrioseptopexy or surgical repair of ventricular septal defect under CPB were randomly divided into two groups of 10 patients. The patients in the ulinastatin group (U), 5 males and 5 females, aged 6.7±2.6, received ulinastatin 12 000 unit/kg, half of the dose being given intravenously 10 min before aorta cannulation and another half being added into the priming fluid. The patients in the control group (C), 6 males and 4 females, aged 5.9±2.7, received the same volume of normal saline instead of ulinastatin. Arterial blood samples were taken before CPB (T_1), at release of the aortic cross-clamp (T_2), 30 min after aortic release (T_3), 4 h and 24 h after discontinuation of CPB (T_4, T_5) for determination of plasma levels of cardiac troponin I (cTnI), creatine phosphokinase (CK) and creatine phosphokinase isoenzyme (CK-MB). Results The CPB time, aortic cross-clamping time and duration of operation were comparable between these 2 groups. The plasma cTnI level and CK and CK-MB activities were all within normal range before CPB in both groups In group C the plasma level of cTnI started to increase at T_2, peaked at T_4 and started to decrease at T_5. In group U the plasma levels of cTnI at T_3 and T_4 were significantly higher than the baseline value (both P <0.01) and returned to the baseline value at T_5. The plasma cTnI levels at T_ 3-5 were significantly lower in group U than in group C (all P <0.01). The plasma CK and CK-MB activities increased significantly at T_ 2-5 in both groups (all P <0.01). There was no significant difference in plasma CK and CK-MB activity at T_ 2-4 between the two groups, but at T_5 their activities were significantly lower in group U than in group C ( P <0.05) . The rate of spontaneous recovery of heart beat without defibrillation was higher in group U (8/10)

关 键 词：乌司他丁 体外循环 心内直视手术 心肌再灌注损伤 保护作用 

分 类 号：R654.1[医药卫生—外科学]