乌司他丁对体外循环心脏手术凝血功能的影响

Effects of Ulinastatin on Blood Coagulative Function at Cardiopulmonary bypass Patients

目的 对比研究乌司他丁对体外循环(CPB)心脏手术患者凝血功能的影响。方法 36例CPB心脏手术患者随机分为3组:试验1组术中应用乌司他丁30万^(KIU);试验2组应用乌司他丁60万^(KIU);对照组除不应用乌司他丁外其它治疗与两试验组相同。动态监测所有患者的凝血因子XI促凝活性(FXI:C)、抗凝血酶Ⅲ活性(AT—Ⅲ:A)和D—二聚体的水平变化;记录3组患者术后住院期间输血量、术后引流量。结果 3组患者术前上述参数组间比较均差异无显著意义(P>0.05);CPB结束和术后6h,试验2组 FXI:C明显高于其它两组(P<0.05);3组AT—Ⅲ:A无显著性差异(P>0.05);从CPB结束至术后24h,试验1组D—二聚体明显高于试验2组(P<0.05),且从术后6h至术后72h两试验组均明显低于对照组(P<0.05或P<0.01);两试验组术后引流量及输血量均明显少于对照组(P<0.01),且两试验组之间比较P<0.05。结论 大剂量乌司他丁能较好地保护凝血因子活性,抑制继发性纤溶亢进,从而减少心脏手术后患者的出血量和住院期间的输血量。

Objective To investigate the effects of Ulinastatin on Blood Coagulative Function at Cardiopulmonary bypass. Methods 36 patients with cardiopulmonary bypass were divided into test group Ⅰ, test group Ⅱ and control group. The parameters of the FactorⅪ procoagulant activity (FXI: C), Antithrombin- Ⅲ activity (AT-Ⅲ: A) and D-dimer were measured on different time and the allogeneic blood transfusions and the postoperation 48hr chest tube drainage were recorded. Results The changes of the FactorⅪ procoagulant activity in test group Ⅱ were significantly higher on CPB finished and after 6hr postoperation than those in control group and test group I(P<0. 05), the changes of Antithrombin-Ⅲ activity in the three groups have no different and the changes of D-dimer in test group Ⅱ were significantly lower from CPB finished to 24hr postoperation than those in control group and test group Ⅰ(P<0. 05 or P<0. 05). The allogeneic blood transfusions and the postoperation 48hr chest tube drainage in the both test groups were significantly less than those in control group (P <0. 01). Conclusion High-dose ulinastatin has a better protection at coagulative function, and it will be reduced postoperative blood loss and allogeneic blood transfusions.