乌司他丁对心肺转流心脏手术肺损伤的保护作用  

Protective effect of ulinastatin on pulmonary function during cardiopulmonary bypass

作　　者：李颖川[1] 姜桢[1] 金翔华[1] 罗江[1] 郭克芳[1] 

机构地区：[1]复旦大学附属中山医院麻醉科,上海市200032

出　　处：《临床麻醉学杂志》2004年第2期69-72,共4页Journal of Clinical Anesthesiology

摘　　要：目的　探讨尿蛋白酶抑制剂乌司他丁在心肺转流 (CPB)中对肺损伤的保护作用。方法　 2 0例心脏瓣膜置换手术的患者 ,随机分为用药组 (U组 )和对照组 (C组 )。分别于CPB前 5min及主动脉开放前 5min ,两次经肺动脉注入乌司他丁 6 0 0 0U/kg或等量生理盐水。并于CPB前、主动脉开放前 10min、主动脉开放后 30、6 0及 12 0min五个时段收集右心房血 (RA)和左心房血 (LA) ,测定其中性粒细胞计数、粘附分子CD18的表达、肿瘤细胞因子 α(TNF α)、白细胞介素 6 (IL 6 )及白细胞介素 8(IL 8)含量。结果　 (1)血中性粒细胞计数 :主动脉开放后 ,U组明显低于C组 (P <0 0 5 ) ,C组LA显著低于RA(P <0 0 5 ) ,而U组LA仅略低于RA(P >0 0 5 ) ;(2 )CD18表达 :C组在主动脉开放前 10min即明显上调且下降慢 ,与CPB前比较有显著差异 (P <0 0 5 ) ,而U组在主动脉开放前10min稍有增加后迅速下降 ,与CPB前比较无显著差异 (P >0 0 5 ) ;(3)TNF α、IL 6和IL 8含量 :CPB开始后 ,C组明显增加 ,主动脉开放 30～ 6 0min达到高峰 ,12 0min仍维持较高水平 ;U组虽也明显升高 ,但开放后显著低于C组 (P <0 0 5 )。主动脉开放后 30及 6 0min ,C组LA显著低于RA(P <0 0 5 ) ,而U组LA与RA无显著差异 (P >0 0 5 )。Objective To determine the protective effect of ulinastatin on the lung injury during cardiopulmonary bypass(CPB).Methods Twenty adult patients under CPB were randomly divided into group U(treated with ulinastatin)and group C as the control group.Blood sample was collected from Swan-Ganz catheter(as right atrium blood,RA)and from radial artery(as left atrium blood,LA)for the measurements of the neutrophil count,and the expression of adhesion molecule CD18 and the concentration of TNF-α,IL-6 and IL-8 at five time points:before CPB,at 10 min before and 30 min,60 min,120 min after release of the aortic cross-clamp.Results (1)Aftre release of the aortic cross-clamp,neutrophil count was obviously lower in group U than that in group C(P<0.05).(2)In group C, CD18 expression increased more obviously at 10 min before CPB than that at 30 min,60 min,120 min after release of the aortic cross-clamp(P<0.05),which was not in group U.(3)The plasma concentration of TNF-α,IL-6,IL-8 increased significantly during CPB,and reached to a peak value at 30-60 min after release of the aortic cross-clamp,and remained at a high level at 120 min after release of the aortic cross-clamp.In group U those were also obviously increased,but the level was significantly lower than that in group C(P<0.05).In group C the level of TNF-α,IL-6,IL-8 was significantly lower in LA than that in RA at 30 min and 60 min after release of the aortic cross-clamp(P<0.05),which was not significantly different between LA and RA in group U. Conclusion During heart surgery under CPB,ulinastatin administered through pulmonary artery could inhibit neutrophils adhering,aggregating and activating in the lungs and decrease both adhesion molecule expression and cytokinin releasing,which is in favour of protecting the lungs from CPB.

关 键 词：乌司他丁 心肺转流 CPB 心脏手术 肺损伤 中性粒细胞 尿蛋白酶抑制剂 细胞因子 粘附分子 

分 类 号：R614[医药卫生—麻醉学]