乌司他丁在腹主动脉瘤切除术中对肺的保护作用

Protective effect of ulinastatin on lung in patients undergoing abdominal aortic aneurysmectomy

目的探讨乌司他丁在腹主动脉瘤切除术中开放主动脉阻断后对缺血再灌注损伤和肺动脉压升高的预防作用。方法行腹主动脉瘤切除术的16例腹主动脉瘤患者分为2组,每组8例。观察组患者在开放腹主动脉阻断前静脉推注30万U乌司他丁;对照组患者同期未给予任何干预。观察2组患者心率(HR)、中心静脉压(CVP)、平均肺动脉压(MPAP)、肺动脉楔压(PAWP)、平均动脉压(MAP)、混合静脉血氧饱和度(SvO2)及心输出量;采集动脉和混合静脉血检测pH值、二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、血红蛋白和血氧饱和度(SvO2),并计算肺分流指数;测定2组患者血液丙二醛(MDA)、髓过氧化物酶(MPO)、粒细胞弹性蛋白酶(GEL)、α1-抗胰蛋白酶(α1-AT)、血栓素B2(TXB2)等免疫学指标。结果开放主动脉阻断前2组患者的主动脉阻断时间、手术时间、失血量、补液量、HR、MAP、MPAP、CVP、PAWP、SvO2、pH、PaO2、PaCO2比较差别均无统计学意义(P>0.05)。对照组在开放主动脉阻断后10 min时MPAP明显高于主动脉阻断前(P<0.05),而观察组开放主动脉阻断后MPAP与阻断前比较差别均无统计学意义(P>0.05)。开放主动脉阻断前后,2组MDA、TXB2、GEL、α1-AT水平比较均无明显变化(P>0.05);对照组开放主动脉阻断后10、30、60 min时,观察组开放主动脉阻断后30、60 min时,血浆MPO水平显著低于主动脉阻断前(P<0.05)。在开放主动脉阻断后,对照组肺分流指数逐步升高,阻断后60 min时,对照组的肺分流指数明显高于主动脉阻断前(P<0.05);而观察组的肺分流指数则逐步降低,阻断后60 min时,观察组肺分流指数明显低于开放主动脉阻断前(P<0.05)。结论乌司他丁在腹主动脉瘤切除术中开放主动脉阻断后能有效预防一过性的肺动脉压升高及肺内分流。

Objective To explore the preventive effect of ulinastatin on ischemia-reperfusion injury and increase in pulmonary arterial pressure after aortic unclamping during abdominal aortic aneurysmectomy.Methods Sixteen patients undergoing abdominal aortic aneurysmectomy were divided into two groups,eight cases in each group.The patients in observation group were treated with ulinastatin 300 000 U intravenously before aortic unclamping,but the patients in control group didn′t received any intervention.The heart rate（HR）,central venous pressure（CVP）,mean pulmonary arterial pressure（MPAP）,pulmonary arterial wedge pressure（PAWP）,mean arterial pressure（MAP）,mixed venous oxygen saturation（SvO2） and cardiac output of patients in two groups were monitored.Arterial and mixed venous blood samples of patients in two groups were analyzed for pH,PaCO2,PaO2,hemoglobin and oxygen saturation,and the index of pulmonary shunt were calculated.In two groups,patients′ immunological indexes,such as blood malondialdehyde（MDA）,myeloperoxidase（MPO）,granulocyte elastase（GEL）,alpha 1-antitrypsin（α1-AT） and thromboxane B2（TXB2） were measured.Results There were no significant differences（P0.05） in aortal interrupted time,operating time,blood loss volume,fluid replacement volume,HR,MAP,MPAP,CVP,PAWP,SvO2,pH,PaO2 and PaCO2 between two groups.In control group,patients′ MPAP was obviously higher at 10 minutes later after aortic block than before（P0.05）.However,in observation group,there were no significantly differences between the result after aortic block and before it（P0.05）.Before and after aortic unclamping,there were no obviously changes between MDA,TXB2,GEL,α1-AT of patients in two groups（P0.05）.10,30 and 60 minutes after control group′s aortic unclamping,and 30,60 minutes after observation group′s aortic unclamping,the level of blood plasma MPO was obviously lower than that of before aortic unclamping（P0.05）.After aortic unclamping,the index of pulmonary shunt of patients in control group increased gradually.60 minutes after interrupting,the pulmonary shunt index of patients in control group were obviously higher than that before interrupting（P0.05）.However,in observation group,the index of patients′ pulmonary shunt was completely opposite.Conclusion The study demonstrated that ulinastatin can effectively prevent from increasing in pulmonary arterial pressure（PAP） and pulmonary shunt after aortic unclamping in patients undergoing abdominal aortic aneurysmectomy.