乌司他丁在体外循环中应用对机体的保护作

Protective effect of ulinastatin during cardiopulmonary bypass

目的 :探讨体外循环 (CPB)中应用乌司他丁对机体的保护作用及其剂量 效应相关性。方法 :择期CPB下心内直视术 30例 ,分为 2组。乌司他丁(UTI)组 (n =1 5) ,于麻醉后、CPB开始前将UTI2 0万U溶于 2 0mL氯化钠注射液中静脉推注 (约1 0min) ;如CPB时间超过 4h ,可在CPB开始 4h后追加一次 ,剂量用法同前。对照组 (n =1 5) ,不用UTI。分别于麻醉前及CPB后检测 β 葡萄糖醛酸酶(β GCD)、粒细胞弹性蛋白酶 (GEL)、纤维连接蛋白(FN)及肾功能各指标。结果 :CPB后 ,UTI组病人β GCD[(2 5 .1±s 2 .8) μmol·h-1 ·L-1 ]活性及GEL[(1 .3± 0 .5) μg·L-1 ]含量均较对照组低 ,但FN[(2 1 7± 39)mg·L-1 ]含量较对照组高 (P <0 .0 5)。UTI剂量与△β GCD ,△GEL及△FN均呈负相关 ,且相关性显著。UTI组尿N 乙酰氨基葡萄糖苷酶、视黄醇结合蛋白、γ 谷氨酰转肽酶、α1 微球蛋白均低于对照组 ,但排尿量/输液量高于对照组(P <0 .0 5)。结论 :体外循环中应用UTI通过抑制β GCD活性和GEL含量的升高及抑制FN含量的下降达到对机体的保护作用 。

AIM: To investigate protective effects of ulinastatin and their dose-effects relationships during cardiopulmonary bypass (CPB). METHODS: Thirty patients (M19,F11;age(18±s 8)a; ASA grade Ⅱ-Ⅲ;undergo ing elective open heart surgery under CPB )were divided into two groups. Ulinast atin(UTI) group (n=15) received UTI 200 kU in 20 mL sodium chloride injectio n by intravenous infusion (about 10 min) after general anesthesia and before CPB, and administrated the same again if those who undergoing CPB more than 4 h . Control group (n=15) received no ulinastatin. β-glucuronidase(β-GC D), gra nulo cyte elastase(GEL), fibronectin (FN) and the indexes of renal function were mea sured before anesthesia and after CPB, respectively. The linear correlation and regression between the dose of ulinastatin and △β-GCD, △GEL, or △FN were st udied, respectively. RESULTS: The serum GEL level ((1.3±0.5) μg·L -1 ) and β-GCD activi ty ((25.1±2.8) μmol·h -1 ·L -1 ) were obviously lower in UTI group th an those in control group, while the serum FN level ((217±39) mg·L -1 ) in UTI group was obviously higher than that in control group (P<0.05). The relationships between the dose of ulinastatin and △β-GCD, △GEL, or △FN were significantly negative correlation (r= -0.7754, r=-0.6967, r=-0. 8076 ), respectively (P<0.01). The levels of urine-γ-GTP, urine-NAG, urine- RBP and urine-α1-MG were all obviously lower in UTI group than those in contr ol group (P<0.05 or P<0.01). But the ratio of urination volume to tran sfusion volume in UTI group was higher than that in control group (P<0.05). CONCLUSION: UTI in patients who undergoing CPB can cause protective effects b y inhibiting GEL level, β-GCD activity and increasing FN level. Those dose-ef fects relationships are obviously positive.