乌司他丁对体外循环心脏直视手术患者血液保护作用的临床研究

THE CLINICAL STUDY ON THE BLOOD PROTECTIVE EFFECT OF ULINASTATIN DURING OPEN HEART SURGERY PERFORMED WITH CARDIOPULMONARY BYPASS

目的 探讨乌司他丁（Ulinastatin）在体外循环心脏直视手术患者围体外循环（CPB）期通过抑制纤溶酶、保护血小板的功能达到血液保护的作用。方法 选择60例CPB病人，随机分为乌司他丁组、抑肽酶组和对照组。乌司他丁为1万U／kg、抑肽酶（Aprotinin）为10万U／kg分别以生理盐水溶解稀释至20ml，对照组为20ml生理盐水，分别于麻醉诱导后经外周静脉用微量泵30min泵入。分别于麻醉后（T1）、CPB30min（T2）、手术结束（T3）、手术结束后24h（T4）4个时点自挠动脉取血，测定血浆栓溶二聚体（D-二聚体）、GpⅠb和GpⅡb／Ⅲa的浓度，记录术后胸腔引流量。结果三组血浆D-二聚体浓度于T2、T3、T4时点明显升高（P〈0．05），但组间比较乌司他丁组、抑肽酶组于T2、T3、T4时明显低于对照组（P〈0．05～0．01）；GpⅠb的变化与基础值相比，对照组的其余各时点和乌司他丁组、抑肽酶组两组的T2、T3时点，均显著下降（P〈0．01），两组与对照组相比在T2、T3、T4时差异有显著性（P〈0．01）；GpⅡb／Ⅲa的变化与GpⅠb的变化趋势基本一致；胸腔引流量乌司他丁组、抑肽酶组术后胸腔引流量明显少于对照组（P〈0．01）。乌司他丁组和抑肽酶组相比，各指标差异无显著性意义。结论 本实验证实，在体外循环心脏直视手术期间血液纤溶系统亢进，血小板功能受损，乌司他丁在一定程度上抑制了纤溶系统的过度激活，保护了血小板的功能．具有和抑肽酶相似的血液保护作用。

Objective To evaluate the blood protective effect of ulinastatin through restraining fibrinociase and protecting the function of platelet during open heart surgery performed with cardiopulmonary bypass（CPB）. Methods Sixty patients undergoing cardiac surgery under CPB was randomly divided into three groups of twenty patients： ulinastain, aprotinin and control groups. 10000u/kg of Ulinastain and 100000u/kg of aprotinin were dissolved with 20ml saline separately. In the control group, patients received normal saline. All these drugs were given in 30 min through peripheral vein after anesthesia induced separately. Blood samples were taken immediately after anesthesia（T1 ）, 30min after CPB（T2 ）, at the end of operation （T3 ）, and 24h after operation （T4） for determination of plasma levels of D-Dimer, GpⅠb and Gp Ⅱ b/Ⅲ a. The blood loss after operation was recorded. Re. sults The plasma levels of D-Dimer were significantly increased at T2, T3 and T4 （ P 〈 0.05） in the three groups,but in lower group U and group A are than in group（C）（P〈0.05-0.01）.The levels of Gp Ⅰb significantly decreased at T2 ,T3 and T4 in group C,and at T2 ,T3 in group U and group A （ P 〈0.01） ,There is significantly difference between the two groups and group C. Conclusion The change of Gp Ⅱ b/Ⅲ a is similar to that of Gp Ⅰ b. There was significantly less postoperative blood loss in group U and group A. All index are similar in group U and group A. Ulinastain has the same protective effect on blood as aprotinin.