联合应用乌司他丁和氨甲环酸对心脏瓣膜置换患者的心肌及血液保护作用

The myocardial and blood protective effects of ulinastatin combined with tranexamic acid in patients underwent valve replacement surgery with cardiopulmonary bypass

目的研究联合应用乌司他丁和氨甲环酸对心脏瓣膜置换患者的心肌及血液保护作用。方法选取2010年12月至2011年12月体外循环下行心脏瓣膜置换术患者80例,随机分为对照组、乌司他丁组、氨甲环酸组和乌司他丁+氨甲环酸复合组,每组20例。记录围术期各项临床参数,包括术中心脏复跳情况、体外循环时间、后并行时间、升主动脉阻闭时间、术后大剂量正性肌力药物使用例数、引流量、输血量、呼吸机辅助呼吸时间、ICU时间、并发症发生和住院死亡情况。检测不同时间点血液中血小板计数、血浆肌钙蛋白I(cTnI)、肌酸激酶同工酶(CKMB)含量。结果术后住院死亡4例,发生并发症5例。四组患者术后住院死亡和并发症的发生率无显著差异,呼吸机辅助呼吸时间、ICU时间与术后住院时间无显著差异。与对照组相比,其他三组术后血小板计数显著上升(P<0.05)。术中体外循环后并行时间复合组显著低于对照组(P<0.05),术后血浆中CKMB、cTnI含量、出血量和输血量均显著下降(P<0.05)。结论乌司他丁复合氨甲环酸用于心脏瓣膜置换术对心肌和血液具有良好保护作用,促进患者术后恢复。

Objective To study The myocardial and blood protective effects of ulinastatin combined with tranexamic acid in patients underwent valve replacement surgery with cardiopulmonary bypass （CPB）. Methods From December 2010 to December 2011, 80 eligible patients scheduled for valve replacement surgery under CPB were ratadomly divided into 4 groups （n = 20） ： control group, ulinastatin group, tranexamic acid group and ulinastatin ＋ tranexamie acid combination group. Intra - operative parameters and post - operative parameters including mortality, complications, high dose of inotropic drugs use, ventilation time, ICU time, hospital time, and drainage and transfusion volumes were recorded. Serial serum troponin I （eTnI）, creatine kinase isoenzyme （CKMB） and platelet counting were examined. Results Four patients died after the surgery, and severe complications happened in 5 patients. The hospital mortalities and morbidities were not significantly different among the four groups. The post - operative ventilation time, ICU time and hospital time were not significantly different either. Compared with the control group, the post - CPB platelet counting in other 3 groups were significantly higher （ P 〈 0.05 ）. The CPB time after aortic crossclamping removal was significantly shorter in the combi- nation group than in the control group （24 ± 17 min vs 32 ±13 rain, P 〈0.05）. Post operative serial serum cTnI and CKMB concentrations were significandy lower in combination group than they were in control group. There were less drainage and transfusion in combination group than in control group. Conclusion For patients undergoing valve replacement surgery with CPB, the peri - oper- ative combination use of ulinastatin and tranexamic acid has significant myocardial and blood protective effects.