体外循环中乌司他丁对血小板的保护作用

Platelets protective effect of ulinastatin during cardiopulmonary bypass

目的探讨乌司他丁在体外循环(CPB)中对血小板的保护作用及其临床意义。方法38例心脏手术随机分为两组:乌司他丁组(20例)在转流前静脉注入、预充液及转流液中加入乌司他丁各30万单位;对照组(18例)同时加入等量0.9%氯化钠注射液。在全身肝素化前、肝素化后10min、转流30min、转流结束肝素中和后10min及术后24h分别检测两组病人血小板数(PLT)、血小板最大聚集率(PAGM)及血小板膜糖蛋白(CD41a、CD42a、CD61、CD62p)阳性表达量和平均荧光强度(MFI)的变化。结果肝素化前两组各项指标差别均无显著性意义。肝素化后10min乌司他丁组CD62p阳性表达量和MFI明显低于对照组(P<0.05或P<0.01);转流30min和转流结束肝素中和后10min乌司他丁组PLT、PAGM及CD41a、CD42a、CD61、CD62p的MFI和CD62p阳性表达量与对照组比较差别均有显著性意义(均P<0.05或<0.01);术后24h乌司他丁组PLT、PAGM及CD42a、CD61、CD62p的MFI和CD62p阳性表达量与对照组比较差别均有显著性意义(均P<0.05或<0.01)。对照组术后24h与肝素化前比较,PLT、PAGM及CD42a、CD61、CD62p的MFI和CD62p阳性表达量的差别有显著性意义(均P<0.05或<0.01);乌司他丁组术后24h与肝素化前比较,只有PAGM及CD62p阳性表达量的差别有显著性意义(P<0.05或P<0.01)。

Objective Discussion on platelets protective effect of ulinas tatin during cardiopulmonary bypass(CPB) and the significance of clinical applic ation. Methods 38 cases patients who underwent open heart surgery with CPB were assigned randomly into ulinastatin treatment group (20 cases) and control group (18 cases using saline as placebo). Platelet counting(PLT), maximum platelet ag gregation ratio(PAGM), positive expression amount of platelet membrane glycoprot ein(CD41a、CD42a、CD61、CD62p)and the mean level of fluorescence intensity (MFI) wer e measurement before systemic heparinization, 10 minutes after heparin injection , 30 minutes after CPB beginning, 10 minutes after protamin neutralization when patients were separated from CPB. Results No significant differences were foun d of all the measurements before heparinization. MFI and positive expression amo unt of CD62p in ulinastatin treatment group were much lower than control group(P <0.05 or P<0.01); There were significant differences of PLT、PAGM 、MFI of CD41 a 、CD42a、CD61 and CD62p、 Positive expression amount of CD62p between the two gr oup s at 30 minutes after CPB beginning and 10 minutes after heparin neutralization( P<0.05). Significant differences of PLT、PAGM、MFI of CD42a、CD61 and CD62p、 Po siti ve expression amount of CD62p were still showed at 24 hours after operation(P<0. 05). The comparison on measurements between 24 hours after operation and at the time before heparinization showed significant differences on PLT、PAGM、MFI of C D4 2a、CD61 and CD62p、Positive expression amount of CD62p in control group(P<0.05) , but only with significant difference on PAGM and positive expression amount of C D62p in ulinastatin treatment group(P<0.05 or P<0.01). Conclusion Platelet prot ection and blood loss reduction can be achieved by application of ulinastatin du ring open heart surgery with CPB.