深低温停循环下大剂量乌司他丁对A型主动脉夹层患者肺脏保护作用的研究

The protective effects of high-dose ulinastatin on pulmonary function in patients with type- A aortic dissection after cardiopulmonary bypass under deep hypothermic circulatory arrest

目的：探讨大剂量乌司他丁在深低温停循环（ DHCA）状态下对主动脉夹层体外循环（ CPB）患者肺脏的保护作用。方法36例急性A型主动脉夹层行DHCA下大血管手术。患者被随机分为乌司他丁组（ n＝18，接受总剂量为20000 IU／kg乌司他丁）和对照组（n＝18，接受等体积的0．9％生理盐水）。在麻醉诱导后（T0），主动脉阻断后30 min（T1）、停机后3 h （ T2）、停机后6 h（ T3）和停机后9 h（ T4）五个时间点测定肿瘤坏死因子（ TNF）－α、白介素（ IL）－6和IL－8，肺功能参数（除外T1）等。结果乌司他丁组细胞炎性因子浓度较对照组在T1到T4之间显著降低，两组均在T2时间点出现峰值。与对照组在T2-T4的肺功能参数相比，乌司他丁组术后肺泡－动脉氧分压差、生理死腔、吸气峰压和平台压均显著降低，且静态顺应性和动态顺应性更好，显著缩短气管插管时间和重症监护室停留时间。结论大剂量乌司他丁可降低DHCA术后患者的细胞炎性因子水平，减少肺部损伤，改善CPB后肺功能，最终缩短气管插管和重症监护室停留时间。

Objective To investigate the protective effects of high-dose ulinastatin on the lung function in patients with aortic dissection after cardiopulmonary bypass （CPB） under deep hypothermic circulatory arrest （DHCA）. Methods Thirty-six patients with acute type-A aortic dissection underwent cardiac surgery using CPB under DHCA. These patients were randomly selected to received total doses of 20,000 units/kg of ulinastatin （ ulinastatin group, n=18） or 0.9% saline （ control group, n=18） at 3 time points （ after anesthetic induction, before aortic cross-clamp, and after aortic cross-clamp released） . Tumor necrosis factor alpha （ TNF-α） , interleukin （ IL） -6, and IL-8 were measured after anesthetic induction （ T0） , 30 minutes （ T1） after aortic cross-clamp, 3 （ T2） , 6 （ T3） and 9 （ T4） hours after weaning from CPB. Except for T1, pulmonary datas, such as alveolar-arterial oxygen pressure difference, physiologic dead space, peak inspiratory pressure, plateau pressure, static compliance and dynamic compliance, were obtained at the same time points. Results Concentrations of cytokines were significantly lower in the ulinastatin group than the control group from T1 to T4. Compared with the pulmonary data of the control group at T2-T4, postoperative alveolar-arterial oxygen pressure difference, physiologic dead space, peak inspiratory pressure, and plateau pressure significantly were lower, and static compliance and dynamic compliance were higher in the ulinastatin group. Significantly shorter intubation time and intensive care unit stay were found in the ulinastatin group. Conclusion High-dose ulinastatin attenuates the elevation of cytokines, reduces the pulmonary injury and improves the pulmonary function after CPB under DHCA. Consequently, it shortens the time of intubation and intensive care unit stay.