心脏瓣膜置换术患者围术期乌司他丁对基质金属蛋白酶9的影响

Effects of Ulinastatin on the Level of Matrix Metalloproteinase-9 in Patients Receiving Cardiac Valve Replacement Therapy

目的观察乌司他丁对心脏瓣膜置换术患者围术期基质金属蛋白酶9的影响,以了解乌司他丁对体外循环所致的肺损伤是否具有保护作用。方法40例择期心脏瓣膜置换术患者,随机分为2组(每组20例)。乌司他丁组按12ku/kg体重计算乌司他丁用量,分别在麻醉诱导和心肺转流开始时按6ku/kg静注乌司他丁共两次,对照组用等量生理盐水替代,用法同乌司他丁组。分别于麻醉诱导前,心脏直视手术体外循环10min,30min,心脏直视手术体外循环后1h,3h,6h抽取桡动脉血,用ELISA法测定血浆基质金属蛋白酶9的浓度。同时测定诱导前,心脏直视手术体外循环后1h,3h,6h等时间点的肺死腔率和血浆肺泡动脉血氧分压差。结果两组患者年龄、体重、性别比、体表面积、血红蛋白、红细胞压积、术前心肺功能,病种,总转流时间、主动脉阻断时间,手术类别和手术时间的变化均无统计学意义。心脏直视手术体外循环10min至循环后6h两组基质金属蛋白酶9均较麻醉诱导前明显升高(P<0.05),均在心脏直视手术体外循环达高峰。循环后1h至6h至两组肺死腔率,肺泡动脉血氧分压差均较诱导前明显升高(P<0.05),肺死腔率在体外循环后1h达高峰,肺泡动脉血氧分压差在体外循环后3h达高峰。乌司他丁组体外循环30min至体外循环后6h时基质金属蛋白酶9和循环后1h至6h肺死腔率,肺泡动脉血氧分压差均明显低于对照组(P<0.05)。结论乌司他丁能明显减轻心脏瓣膜置换术患者围术期基质金属蛋白酶9的过度释放,减轻术后早期肺死腔率和肺泡动脉血氧分压差,对改善肺氧合保护肺功能有一定的作用。

Aim To observe the effects of ulinastatin （UTI） on the level of matrix metalloproteinase-9 on plasma in patients receiving cardiac valve replacement therapy and to investigate the protective effects of Ulinastatin on lung injury. Methods 40 adult patients, ASA score Ⅱ～Ⅲ, scheduled for elective cardiac valvular replacement, were randomly allocated into two groups, Ulinastatin group （group U, n=20） and control group （group C, n=20）. Group U in which patients received a total of 12 ku/kg of ulinastatin. 6 ku/kg ulinastatin was given a IV bolus on introduction of anesthesia and before CPB. Group C received an equal amount of isotonic sodium chloride solution. Blood samples were taken from radial artery before introduction of anesthesia, 10 min after initiation of CPB, 30 min after initiation of CPB, 1 h, 3 h and 6 h after CPB for determination of plasma matrix metalloproteinase-9 concentrations. VD/VT and alveolar-arterial oxygen A-aDO2 were checked before introduction of anesthesia, 1 h, 3 h, 6 h after initiation of CPB studied after CPB. Results There was no significant difference between two groups in age, weight, operation time, CPB time, and aortic cross-clamping time. Compared with those before introduction of anesthesia, the concentrations of matrix metalloproteinase-9 increased significantly at 10 min after initiation of CPB to 6 h after initiation of CPB in two groups （P〈0.05）. And no difference between two groups before introduction of anesthesia. The concentration of VD/VT at 1 h after initiation of CPB to 6 h after initiation of CPB increased significantly （P〈0.05）. The concentrations of MMP-9 at 10 min after initiation of CPB to 6 h after initiation of CPB, VD/VT A-aDO2 at 1 h after initiation of CPB to 6 h after initiation of CPB in ulinastatin group was lower than those in control group significantly （P〈0.05）. Conclusions Ulinastatin suppressed the excessive release of matrix metalloproteinase-9 and protected lung injury in patients undergoing cardiopulmonary bypass.