N-乙酰半胱氨酸联合乌司他丁对行冠脉旁路移植术患者肺功能的影响

Influence of N-acetylcysteine combined ulinastatin on pulmonary function in patients undergoing coronary artery bypass grafting

目的:探讨N-乙酰半胱氨酸(NAC)联合乌司他丁对行冠状动脉旁路移植术(CABG)患者肺功能的影响。方法:我院需实施CABG患者94例被随机均分为乌司他丁组和联合治疗组(在乌司他丁组基础上增加NAC治疗)。对比两组患者术后机械通气时间、住院时间、肺功能指标变化及预后。结果:与乌司他丁组比较,联合治疗组手术时间[(172.35±10.70)min比(177.98±10.56)min]显著增加,术后机械通气时间[(23.41±6.27)h比(15.98±6.34)h]、住院时间[(24.11±3.33)d比(21.39±3.45)d]显著缩短(P<0.05或<0.01),治疗后动脉血氧分压[(85.47±9.16)mmHg比(98.26±8.96)mmHg]、氧合指数[(504.41±44.76)mmHg比(541.53±42.92)mmHg]均显著提高,肺泡-动脉氧分压差[(51.69±7.42)mmHg比(42.13±8.64)mmHg]、呼吸指数[(0.60±0.26)比(0.43±0.12)]显著降低(P均=0.001);治疗后两组血清白介素(IL)-6、IL-8、CD11b/CD18水平均比治疗前显著升高(P均=0.001),但联合治疗组上述炎症因子水平均显著低于乌司他丁组(P均=0.001);两组术后均无严重感染、气胸等并发症,无患者死亡。结论:N-乙酰半胱氨酸联合乌司他丁可显著抑制冠脉手术患者的炎症反应,改善肺功能,减轻肺损伤。

Objective:To explore influence of N-acetylcysteine(NAC)combined ulinastatin on pulmonary function in patients undergoing coronary artery bypass grafting(CABG).Methods:A total of 94 patients needed CABG from our hospital were randomly and equally divided into ulinastatin group and combined treatment group(received NAC based on ulinastatin group).Postoperative mechanical ventilation time,in-hospital time,pulmonary function indexes and prognosis were compared between two groups.Results:Compared with ulinastatin group,there was significant rise in surgery time[(172.35±10.70)min vs.(177.98±10.56)min],and significant reductions in postoperative mechanical ventilation time[(23.41±6.27)h vs.(15.98±6.34)h]and in-hospital time[(24.11±3.33)d vs.(21.39±3.45)d],P<0.05 or<0.01;significant rise in partial pressure of oxygen in artery[(85.47±9.16)mmHg vs.(98.26±8.96)mmHg],oxygenation index[(504.41±44.76)mmHg vs.(541.53±42.92)mmHg],and significant reductionsin alveolar-arterial oxygen difference[(51.69±7.42)mmHg vs.(42.13±8.64)mmHg],respiratory index[(0.60±0.26)vs.(0.43±0.12)]in combined treatment group after treatment,P=0.001 all.After treatment,serum levels of interleukin(IL)-6,IL-8 and CD11b/CD18 were significantly higher than those of before treatment in two groups(P=0.001 all),but levels of above inflammatory factors in combined treatment group were significantly lower than those of ulinastatin group,P=0.001 all;there were no severe infections,pneumothorax and death in two groups after surgery.Conclusion:N-acetylcysteine combined ulinastatincan significantly inhibit inflammatory reactions,improve pulmonary function and relieve pulmonary injury in patients undergoing coronary surgery.