乌司他丁对心肺转流心脏手术病人脑氧代谢的影响

Effects of ulinastatin on cerebral oxygen metabolism during cardiopulmonary bypass

目的探讨乌司他丁对心肺转流(CPB)心脏手术病人脑氧代谢的影响。方法选择24例择期行心脏瓣膜置换术病人,随机分为乌司他丁组(U组)和对照组(C组),每组12例。U组共给予乌司他丁2·4万U/kg,其中1·2万U/kg于麻醉诱导后静脉推注,0·6万U/kg加入CPB预充液中,随转流进入体内,0·6万U/kg于主动脉开放前约5min加入CPB机内。C组用等量的生理盐水代替。于麻醉后手术前(T1)、低温稳定期(T2)、复温至36℃(T3)、CPB结束后60min(T4)、CPB结束后6h(T5)同时抽取动脉血与颈静脉球血,进行血气分析和动脉血、颈静脉球血乳酸(AL、VL)测定并计算动脉血氧含量(CaO2)、动脉-颈内静脉血氧含量差(Ca-jvO2)、脑乳酸生成量(AVDL)与乳酸氧指数(LOI)。结果C组Ca-jvO2于T2至T5、U组于T2至T4均有不同程度降低(P<0·05);两组AL、VL于T2至T5进行性升高,AVDL、LOI于T4、T5高于T1至T3。两组间CaO2各时点无显著性差异;U组颈静脉球血氧饱和度(SjvO2)、AL、VL、AVDL、LOI于T4、T5时明显低于C组(P<0·05或P<0·01);U组Ca-jvO2于T4、T5时明显高于C组(P<0·05或P<0·01)。结论乌司他丁可以减轻CPB引起的脑无氧代谢,改善脑氧摄取与利用。

Objective To investigate the effects of ulinastatin（UTI） on cerebral oxygen metabolism during cardiopulmonary bypass（CPB）. Methods Twenty-four patients undergoing elective cardiac valve replacement under hypothermic CPB were randomly divided into ulinastatin group （group U,n=12） and control group （group C,n=12）. In group U, UTI 12 000 U/kg was given iv after induction of anesthesia,6 000 U/kg was added to the priming solution and 6 000 U/kg was given about 5 min before aortic decalmping. In group C, normal saline was given instead of UTI. Internal jugular vein was cannulated and the catheter was advanced retrogradely till the jugular bulb. Blood samples were taken simultaneously from artery and jugular bulb after induction of anesthesia（T1 ）, when hypothermia was being stably maintained（T2 ）, when the patients were rewarmed to 36℃ （T3）, at 60 rain （T4） and 6 h （T5） after discontinuation of CPB, for determination of jugular bulb blood saturation （SjvO2）, arterial-venous oxygen content difference （Ca-jvO2）, arterial- cerebral venous blood lactate difference （AVDL） and lactate oxygen index （LOI）. Results Ca-jvO2 decreased from T2 to Ts in group C and from T2 to T4in group U（P〈0. 05）. ALand VL increased from T2 to T5 progressively. AVDL and LOI were higher at T4 and T5 than those from T1 to T3 （P〈0. 05）. SjvO2, AL, VL, AVDL and LOI were lower in group U than those in group C at T4 and T5 （P〈0.05 or P〈0. 01）. Ca-jvO2 was higher in group U than that in group C at the same time （P〈0.05 or P〈0.01）. Conclusion Ulinastatin can alleviate cerebral anaerobic metabolism during CPB by improving the ability of brain tissue oxygen intake and utilization.