乌司他丁对肢体缺血再灌注致肺功能损伤防护效果研究

Protective Effects of Ulinastatin Injection on Lung Injury Induced by Limb Ischemia Reperfusion in Pa tients Undergone Lower Limb Surgery

目的:观察乌司他丁对肢体缺血再灌注(LIR)致肺功能损伤的防护效果并探讨其保护机制。方法:选择应用止血带的下肢手术病例30例,随机分为对照组和乌司他丁组,各15例。对照组在上止血带前10min静滴生理盐水100mL;乌司他丁组则在相同时间内静滴乌司他丁注射液(0.6×104U/kg)100mL,于上止血带前(T0)、上止血带后1h(T1)、松止血带后0.5h(T2)、2h(T3)、6h(T4)、24h(T5)取血进行血气分析,计算P(A-a)DO2和OI值,并测定血浆中NO、ET-1、IL-6浓度值。结果:对照组在T4时点P(A-a)DO2值较T0点增大(P<0.01),乌司他丁组各时点组内变化无统计学意义(P>0.05);乌司他丁组T4时点的差值增大幅度小于对照组(P<0.05)。各组OI值变化与P(A-a)DO2值相反,而两组PaCO2值在T2、T3时都有升高(P<0.01),T4时点恢复,且两组间差异无统计学意义(P>0.05)。两组T1、T2、T3、T4时血浆NO浓度下降,乌司他丁组下降幅度小于对照组,且在T3、T4时NO浓度高于对照组(P<0.01)。而两组血浆ET-1、IL-6浓度变化则刚好相反。结论:乌司他丁通过抑制炎性细胞与血管内皮细胞黏附、抑制ET-1释放、减轻NO消耗、抑制体液炎性因子的过度作用,减轻肢体缺血再灌注对肺的损伤,改善LIR后的肺氧合功能。

Objective： To investigate the protective effects of ulinastatin injection on acute lung injury induced by limb ischemia reperfusion. Methods： Thirty patients undergoing lower limb surgery were intravenously adminis- tered ulinastatin （0.6×104U/kg,100mL, group U） or saline （100 ml, group C） at 10 minutes before application of tourniquet. P（A-a）DO2 and oxygenation index （OI） were calculated by measuring PO2 and PaCO2 from blood gas analysis and nitrous oxide, endothelin-1, and IL-6 concentrations were determined from plasma samples before an- esthesia（T0）, lh after tensing the tourniquet（T1）, and 30min（T2）, 2h （T3）, 6h （T4）, and 24h （T5） after releasing the tourniquet. Results： P（A-a）O2 was elevated in T4 when compared with TO in group C （P〈0.01）. P（A-a）O2 re- mained stable at each time point in group U and was lower at T4 than that in group C （P〈0.05）. OI decreased in both groups. PaCO2 increased at T2 and T3 （P〈0.01） and the increase disappeared at T4 in both groups, with- out a significant difference of PaCO2 at T4 between the 2 groups （P〉0.05）. NO concentration was reduced from T1 to T4 after limb ischemia reperfusion in both groups, but the range of decrease was smaller in group U than that in group C, with a significantly higher NO concentration at T3 and T4 in group U than that in group C （P〈 0.01）. The alteration of ET-1 and IL-6 concentrations was opposite to NO. Conclusions： Ulinastatin Injection can alleviate lung injury after limb injury reperfusion by inhibiting endothelin-1 liberation and IL-6 expression and reducing the expansion of nitrous oxide.