乌司他丁在体外循环下冠状动脉旁路移植术中对心肌的保护作用

Myocardial Protection of Ulinastatin in Patients undergoing Coronary Artery bypass Grafting with Cardiopulmonary Bypass

目的观察乌司他丁在体外循环下冠状动脉旁路移植术患者围术期中对心肌的保护作用。方法选择择期在体外循环下行冠状动脉旁路移植术患者60例,随机分为乌司他丁组和对照组各30例。两组均采用静吸复合麻醉。乌司他丁组给予乌司他丁100万U(其中30万U为麻醉诱导前给予,40万U预充体外循环机内,30万U为开放升主动脉后给予);对照组不给予其他药物。分别于麻醉诱导后(t1)、阻断升主动脉30min(t2)、再灌注1h(t3)、再灌注6h(t4)及再灌注24h(t5)各时间点取动脉血,测定红细胞比容(HCT)、血浆肌酸磷酸激酶(CK)活性、肌酸磷酸激酶同工酶(CK-MB)及心肌肌钙蛋白Ⅰ(cTnI)水平。记录体外循环转流时间,主动脉阻断时间,手术时间及术后复跳情况。结果与t1相比,两组患者CK、CK-MB、cTnI在t3、t4、t5均明显升高(P<0.05),其中CK-MB、cTnI均在t4达最高值,t5开始下降。两组患者之间CK、CK-MB、cTnI在t1、t2时无明显差别,对照组CK、CK-MB在t4、t5明显高于乌司他丁组(P<0.05),cTnI在t3、t4、t5明显高于乌司他丁组(P<0.05)。结论在体外循环下冠状动脉旁路移植术患者围术期中使用乌司他丁减轻了体外循环期间心肌缺血-再灌注损伤,起到良好的心肌保护作用。

Objective To observe the protective effects of ulinastatin（UTI）on myocardium during coronary artery bypass grafting（CABG）with cardiopulmonary bypass（CPB）.Methods 60 patients scheduled for CABG with CPB were randomly divided into control group（group C）and ulinastatin group（group U）,30 in each.In group U,the patients received UTI 1 000 000 U in all,300 000 U in which was given intravenously before anesthesia and 400 000 U was added into the primary solution,the last 300 000 U was given after declamping aorta.Control group（group C）did not receive UTI intravenously or in the priming.Plasma levels of CK,CK-MB and cTnI were measured before induction（t1）,30 min following clamping（t2）,reperfusion l h（t3）,reperfusion 6 h（t4）and reperfusion24 h（t5）.Results The plasma level of CK,CK-MB and cTnI increased significantly at t3,t4 and t5 in both groups compared with those at t1（P〈0.05）.The plasma cTnI level of group C at t3,t4 and t5 was significantly higher than that of group U（P〈0.05）,and the plasma CK and CK-MB level of group C at t4,t5 was significantly higher than that of group U（P〈0.05）,respectively.Conclusion Ulinastatin can effectively protect myocardium from ischemia-reperfusion injury during CPB.