白细胞滤器合用乌司他丁对大出血患者肺功能保护作用的研究

Protective effects of leukocyte depletion filter combined with ulinastatin on pulmonary function in patients with massive haemorrhage

目的探讨大出血手术患者自体血回收时应用白细胞滤器联合乌司他丁对肺功能的影响。方法选取60例大出血手术治疗的患者,随机分为对照组、白细胞滤器组(LDF组)、乌司他丁组(UTI组)、白细胞滤器+乌司他丁组(LDF+UTI组),每组15例。术中均使用自体血回输机,回输时LDF组、LDF+UTI组均使用白细胞滤器,UTI组、LDF+UTI组术中静脉滴注乌司他丁20万U,其他组给予等量0.9%氯化钠注射液静脉滴注。4组患者术中和术后连续监测血压和心率的变化。分别于术前(T1)、手术结束时(T2)、术后6 h(T3)、12 h(T4)、24 h(T5)、72 h(T6),抽取动脉血5 ml,检测白细胞计数、中性粒细胞计数、超氧化物歧化酶(SOD)活性、丙二醛(MDA),用酶联免疫吸附法检测血浆炎症细胞因子白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α及中性粒细胞弹性蛋白酶(NE)浓度水平。并进行血气分析,计算呼吸指数(RI)和肺顺应性(CL)。结果与对照组比较,LDF组、UTI组、LDF+UTI组各时间点自体血回输后,白细胞计数和中性粒细胞计数降低,血浆MDA浓度和RI降低,血浆SOD活性升高,NE、血浆TNF-α、IL-6浓度降低(P<0.05),CL增高。LDF+UTI组与其他3组比较各时间段自体血回输后白细胞和中性粒细胞计数明显降低,血浆MDA浓度和RI降低,血浆SOD活性升高,NE、血浆TNF-α、IL-6浓度降低(P均<0.01),CL高于其他3组。结论白细胞滤器及乌司他丁都具有减轻大出血患者自体血回输后的肺损伤的影响,两者合用效果更显著,能有效地减轻全身性炎症反应综合征,阻断多器官功能障碍综合征的发生,能够有效地保护患者的心肺功能,有助于患者平稳地度过围术期。

Objective To investigate the effects of leukocyte depletion filter, during autotransfusion, plus uli-nastatin on pulmonary function in patients with massive hemorrhage. Methods Sixty patients with massive hemor-rhage were randomly divided into 4 groups： control group, leukocyte depletion filter （LDF） group, ulinastatin （UTI） and LDF＋UTI group. Intraoperative blood salvage was applied in all groups. Only LDF groups and LDF＋UTI group received LDF treatment. UTI group and LDF＋UTI group were given intravenous drip with 200 000 U ulinastatin, while the remaining groups were administered an aliquot of natural saline. The changes of intraoperative and postoperative blood pressure and heart rate were monitored continuously. Five ml arterial blood sample was sampled, respectively, before the surgery （T1）, at the end of surgery （T2）, 6 h postoperatively （T3）, 12 h postoperatively （T4）, 24 h postopera-tively （T5）, and 72 h postoperatively （T6） for the detection of white blood cell count （WBC）, polymorphonuclear （PMN） cell count, superoxide dismutase （SOD） activity and the level of methane dicarboxylic aldehyde （MDA）. The concen-tration of serum IL-6, TNF-α and neutrophil elastase （NE） were measured by enzyme-linked immunosorbent assay us-ing the samples for blood gas analysis. Respiratory index （RI） and lung compliance （C L） were calculated. The data were recorded for statistical analysis. Results Compared with control group, the treatment groups consistently yielded a remarkable reduction in WBC, PMN count, the activity of NE, concentration of serum MDA, RI, TNF-α and IL-6, and an increase in serum SOD activity and the level of CL （all P〈0.05）. No remarkable differences in the change be-tween LDF group and UTI group were noted （P〉0.05）. Compared with the remaining groups, LDF＋UTI group was as-sociated with significantly reduced levels of WBC, PMN count, serum MDA and NE activity, RI, serum TNF-α and IL-6, as well as heightened CL and serum SOD activity, all time points of autotransfusion （all P〈0.01）. Conclusion LDF and ULT mitigate the influence of lung injury on patients with massive hemorrhage following autotransfusion. The com-bination of LDF and UTI effectively alleviates the response of SIRS, prevents from the incidence of MODS, and restores cardiopulmonary function in patients with massive hemorrhage, thus securing the transition of preoperative period.