乌司他丁用于肺动脉灌注后对肺功能的影响

The lung protective effect of ulinastatin(UTI) on pulmonary artery perfusion

目的:探讨肺动脉灌注含乌司他丁低温肺保护液后患者肺功能的影响。方法:择期二尖瓣置换手术病人60例,随机分成两组,每组30例,乌司他丁组(乌司他丁0.5万u/kg,加入4℃含氧冷血灌注液中进行肺动脉根部灌注);对照组(4℃含氧冷血灌注液进行肺动脉根部灌注)。检测体外循环(CPB)前、CPB后1/2、6h的肺泡氧和指数(OI)、呼吸指数(RI=A-aDO2/PaO2)。结果:(1)体外循环后1/2h实验组与对照组OI、RI差异无统计学意义,但较术前升高有统计学意义(P<0.01);(2)体外循环后6h实验组OI、RI组明显低于对照组,差异显著(P<0.01)。结论:乌司他丁能通过抑制炎症因子TNF-a的产生,促进抗炎因子IL-10的释放,调整机体促炎系统及抗炎系统动态平衡,从而抑制白细胞的激活、肺内聚集,减轻体外循环后肺损伤和通气功能障碍,减轻肺损伤,改善术后肺功能。

Objective To evaluate the effect of perfusion of pulmonary artery using hypothermic protective solution with ulinastatin （UTI） on the inflammatory response of lung during cardiopulmonary bypass （CPB）. Methods 60 patients undergoing mitral Valve replacement were randomly divided into two groups. The UTI perfusion group（n =30） were perfused 4℃ oxygenated blood with UTI 5000U/kg to the pulmonary artery during CPB. The control group（ n = 30） were perfused 4℃ oxygenated blood to the pulmonary artery during CPB. Record Respiratory index（ RI = A - aDO2/PaO2） and oxygenate index of alveolus（OI） before CPB, 1/2 hour after CPB ,6 hour after CPB. Results （1）At 1/2 hour after CPB the leve of OI,RI were no difference between two groups ,but bigher than the time before CPB, （P 〈0.01）;（2）6 hour after CPB in control group were higher significantly than the time befor CPB and the UTI group in the same time（P 〈0. O1 ）. Conclusion Ulinastatin can adjust the dynamic equilibrium between the prmote inflammation system and anti - inflammation system in restrain inflammatory factor TNF - a, promote anti - inflammatory factorial - 10 release, thereby it restrain leukocytal activation, reduce the lung injury after CPB,improve lung function after operation.