乌司他丁对体外循环患者呼出气冷凝液IL-6、IL-8水平的影响及肺功能保护作用

Effects of ulinastatin on IL-6 and IL-8 levels in exhaled breath condensate and pulmonary function of patients undergoing cardiopulmonary bypass

目的观察乌司他丁对行体外循环(CPB)心脏手术患者呼出气冷凝液(EBC)中IL-6、IL-8水平的影响,并观察其肺功能保护作用。方法择期拟行CPB下心脏手术的患者48例,采用随机数字表法分为乌司他丁组(U组)和对照组(C组),每组24例。U组在CPB预冲液中加入乌司他丁15000 IU/kg,C组给予等量的生理盐水。于气管插管后即刻(T 0)、停CPB后(T 1)、手术结束前30 min(T 2)及术后4 h(T 3)收集EBC标本并记录患者生命体征、血气指标、手术时间、CPB时间、阻断时间、出血量、输血量;采用ELISA法检测EBC中的IL-6、IL-8;记录患者氧浓度(FiO 2)、潮气量(VT)、气道峰压(P peak)、气道平台压(P plat)并计算氧合指数(PaO 2/FiO 2)、肺泡动脉氧分压差[P(A-a)O 2]、呼吸指数(RI);记录患者术后呼吸支持时间、术后拔管时间、住ICU时间、出院时间及术后肺部并发症(PPCs)发生情况。结果U组T 2、T 3时EBC中IL-6水平低于C组,U组T 1~T 3时EBC中IL-8水平低于C组(P均<0.05)。U组T 1~T 3时PaO 2/FiO 2高于C组(P均<0.05)。U组T 1、T 2时P(A-a)O 2、RI低于C组(P均<0.05)。U组术后拔管时间和住ICU时间均短于C组(P均<0.05)。U组PPCs发生率低于C组(P<0.05)。结论乌司他丁可降低心脏手术患者CPB后EBC中IL-6、IL-8水平,改善氧合和肺功能,减少PPCs发生,缩短术后拔管时间和住ICU时间。

Objective To observe the effect of ulinastatin on the levels of IL-6 and IL-8 in the exhaled breath condensate(EBC)and the protective effect of ulinastatin on pulmonary function of patients undergoing cardiopulmonary bypass(CPB).Methods Forty-eight patients undergoing elective cardiac surgery under cardiopulmonary bypass were randomly divided into ulinastatin group(group U)and control group(group C),with 24 cases in each group.Ulinastatin 15,000 IU/kg was added to the CPB preflush for patients in the group U while the same amount of normal saline was given in the group C.EBC specimens were collected and the vital signs,blood gas results,operation duration,CPB duration,block duration,bleeding amount and transfusion volume were recorded immediately after tracheal intubation(T 0),at the end of CPB(T 1),30 min before the end of operation(T 2),4 h after operation(T 3).The levels of IL-6 and IL-8 in EBC were detected by ELISA.Oxygen concentration(FiO 2),tidal volume(VT),peak airway pressure(P peak),plat airway pressure(P plat)were recorded and oxygenation index(PaO 2/FiO 2),alveolar-arterial oxygen partial pressure[P(A-a)O 2]],and respiratory index(RI)were calculated.The time of postoperative ventilator support,time to extubation,length of stay in the ICU,postoperative length of stay,and postoperative pulmonary complications(PPCs)were also recorded.Results The levels of IL-6 at T 2 and T 3 in EBC were lower in the group U than in the group C,the levels of IL-8 at T 1-T 3 in EBC were lower in the group U than in the group C(all P<0.05).The PaO 2/FiO 2 of the group U was higher than that in the group C at T 1-T 3,while both P(A-a)O 2 and RI of the group U were lower than those in the group C at T 1 and T 2(all P<0.05).The time to extubation and length of stay in the ICU were shorter in the group U than in the group C(both P<0.05).The incidence of PPCs in the group U was lower than that in the group C(P<0.05).Conclusion Ulinastatin can reduce the levels of IL-6 and IL-8 in EBC after CPB,improve oxygenation and pulmonary function,reduce the occurrence of PPCs,and shorten the time to extubation and length of stay in the ICU of patients undergoing cardiac surgery.