乌司他丁对体外循环瓣膜置换术患者胃黏膜的保护作用研究

Protective Effect of Ulinastatin on Gastric Intramucosa in patients Undergoing Cardiac Valve Replacement Surgery with Cardiopulmonary Bypass

目的观察乌司他丁对体外循环下瓣膜置换术患者术后胃黏膜的保护作用。方法 60例在体外循环下行瓣膜置换术的心脏瓣膜病患者,随机分为对照组和乌司他丁组,每组30例。乌司他丁组在心肺转流CPB过程中按1.0万u/kg体重加入乌司他丁,而对照组用等量生理盐水替代,用法同乌司他丁组。术后两组患者均接受大便隐血试验及术后6h,12h,24h,48h胃黏膜pH值(pHi)的检测。结果对照组有5例出现咖啡渣样胃液,大便隐血试验阳性7例,而乌司他丁组显著低于对照组(P<0.05),仅1例出现咖啡渣样胃液和大便隐血试验阳性。乌司他丁组的CPB瓣膜置换术患者胃黏膜pHi在术后6 h、12 h、24h和48h均显著高于对照组(P<0.01)。结论乌司他丁可预防CPB瓣膜置换术后应激性溃疡的发生。

Objective To observe the protective effect of ulinastatin on gastric intrarnucosa in patients undergoing cardiac valve replacement surgery with cardiopulmonary bypass （CPB）. Methods 60 patients who were scheduled for cardiac valve replacement surgery with CPB were randomly divided into 2 groups： control group and ulinastatin group, 30 cases in each; ulinastatin 10000 u/kg was given to patients in ulinastatin group during CPB while same volume of normal saline was given to patients in control group at each same time point; after operation, fecal occult blood test and pH of gastric intramucosa（pHi） detection at the time point of 6h, 12h, 24h and 48h were made to all the patients in both groups. Results In control group, gastric juice that looked like coffee grounds was found in 5 cases and positive fecal occult blood test in 7 cases while only 1 case in ulinastatin group had gastric juice like coffee grounds and positive fe- cal occult blood test, the case number was much smaller than that in control group （P〈0.05）; the phi of gastric mucosa of the patients in ulinastatin group at the time point of 6h, 12h, 24h and 48h after cardic valve replacement surgery were significantly higher than those of the patients in control group （P〈0.01）. Conclusions Ulinastatin can prevent the occurrence of stress ulcer after cardiac valve replacement surgery undergoing CPB.