乌司他丁对体外循环心脏手术患者肺炎性反应的影响

Effects of ulinastatin on lung inflammatory response to cardiopulmonary bypass

目的 研究乌司他丁（ulinastatin,uti）对心肺转流（CPB）心脏手术患者肺炎性反应的影响。方法 择期心脏瓣膜置换患者60例,随机分成对照组（I组,n=20）,util万U/kg组（Ⅱ组,n=20）,uti2万 U/kg组（Ⅲ组,n=20）。在 CPB前主动脉开放心脏复跳1、3、5、10 min分别采右心房与肺静脉血检测PMN、CD11b、IL-8、IL-10、MDA和SOD水平。结果 主动脉开放心脏复跳后对照组右心房和肺静脉血中上述指标的水平较CPB前显著性升高（P<0.05）,与对照组比较,乌司他丁两组肺静脉血上述指标的水平明显下降（P<0.05）。结论（1）体外循环过程中肺发生了炎性反应;（2）乌司他丁能减轻CPB肺部的炎性反应,其2万U/kg组抑制炎性反应的效果优于1万U/kg组。

Objective To investigate the effects of ulinastatin(UTI) on lung inflammatory response induced by cardiopulmonary bypass(CPB) .Methods Sixty ASA Ⅱ-Ⅲ patients undergoing elective heart valve replacement were randomly allocated to one of three groups: Group Ⅰ(control group, n = 20) in which patients received ni UTI; in group Ⅱ ( n =20) patients received UTI 10 000 U·kg-1 ; in groupⅢ patients received UTI 20 000 U·kg-1 ( n = 20) . Patients with liver/kidney dysfunction or lung inflammatory disease were excluded. Premedication consisted of intramuscular morphine 5 mg and atropine 0.1mg. Anesthesia was induced with propofol 1.5-2.0 mg·kg-1, fentanyl 5 μg·kg-1 and vecuronium 0.1 mg·kg-1 .After tracheal intubation anesthesia was maintained with iv fentanyl 15·kg-1, propofol 2-4 mg· kg-1?h-1, intermittent boluses of vecuronium supplemented with isoflurane( < 1.5 % ) . The patients were mechanically ventilated with 100 % O2 . Blood samples were taken from right atrium and pulmonary vein simultaneously before CPB and 1, 3, 5, 10 min after release of aortic cross-clamp for determination of PMN count and levels of CDllb(flow cytometry), IL-8, IL-10(ELISA) and MDA, SOD activities.Results Demographic data including age and sex were not significantly different between the three groups. The three groups were comparable with respect to CPB time and lung ischemia time. In group I the right atrial and pulmonary venous blood levels of PMN, CD11b, IL-8, IL-10, MDA and SOD after CPB were significantly higher than baseline (before CPB) and the post-CPB pulmonary venous blood levels were significantly higher those in righ atrial blood. In group Ⅱ and Ⅲ the post-CPB pulmonary venous blood levels of PMN, CDllb, IL-8, IL-10, MDA and SOD were significantly lower than those in group I , and 20 000 U·kg-1 UTI exerted greater inhibition of lung inflammatory response. Conclusions CPB induces lung inflammation and UTI 20 000 U·kg-1 is better than UTI 10 000 U·kg-1 in inhibiting the lung inflammatory response to CPB.