乌司他丁联合甲强龙对体外循环心脏术后全身炎症反应观察

Effect of ulinastatin combined with methylprednisolone on systemic inflammatory response after cardiopulmonary bypass

目的探讨乌司他丁联合甲基强的松龙对体外循环心脏术后的应用价值。方法将2013年3月-2014年3月期间对我院实施体外循环心脏术后90例患者纳入研究对象,根据治疗方法不同分为观察组及对照组,对照组按常规营养心肌细胞支持心功能,预防感染,呼吸机辅助呼吸,地塞米松静注抗炎,观察组在对照组基础上改用乌司他丁联合甲强龙抗炎,比较两组患者的体温、呼吸、心率、中心静脉压、氧合指数、Lac、TNF-α、IL6、CRP、尿蛋白、尿NAG酶的变化。结果观察组的体征指体温心率氧合指数改善明显优于对照组,乳酸、TNF-α、IL6、CRP、等炎症指标及尿蛋白尿NAG酶肾损害指标均明显低于对照组。结论乌司他丁联合甲基强的松龙抗炎能明显改善体外循环心脏术后全身炎症反应,减少对心、肺、肾的损害。

Objective To investigate the effect of ulinastatin combined with methylprednisolone on systemic inflammatory response after cardiopulmonary bypass. Methods A total of 90 patients who received cardiopulmonary bypass from March 2013 to March 2014 in Zhuzhou Kind Cardiovascular Disease Hospital were involved in the study and divided into observation group and control group based on different treatment approaches. The control group was conventionally treated with cardiac muscle nourishment, heart function support, infection prevention, respiration assistance, and intravenous injection of dexamethasone for anti-inflammation, while the observation group, in addition to the conventional treatment, was given ulinastatin combined with methylprednisolone for anti-inflammation. The changes in body temperature, respiration, heart rate, central venous pressure, oxygenation index, lactic acid, tumor necrosis factor-ct （TNF-α）, intedeukin-6 （IL6）, C-reactive protein （CRP）, urine protein, and urinary NAG enzyme between the two groups were compared. Results The observation group had significantly more improvements in body temperature, heart rate, and oxygenation index, and had significantly lower levels of lactic acid, TNF-α, IL6, CRP, urine protein, and urinary NAG enzyme compared with the control group. Conclusion Ulinastatin combined with methylprednisolone can significantly improve systemic inflammation and reduce damages to the heart, lung and kidney after cardiopulmonary bypass.