Ren Tong-yue, Yang Xiao-wei, Ma Yue, Wang Fang, Qiang Wan-dang
Department of Anesthesia, Fourth Central Hospital of Tianjin, Tianjin 300140, China.
Zhonghua Yi Xue Za Zhi. 2003 Aug 25;83(16):1391-3.
To investigate the protective effect of ulinastatin on myocardium against ischemia-reperfusion injury in open heart surgery with cardiopulmonary bypass (CPB).
Twenty ASA I-II patients undergoing atrioseptopexy or surgical repair of ventricular septal defect under CPB were randomly divided into two groups of 10 patients. The patients in the ulinastatin group (U), 5 males and 5 females, aged 6.7 +/- 2.6, received ulinastatin 12,000 unit/kg, half of the dose being given intravenously 10 min before aorta cannulation and another half being added into the priming fluid. The patients in the control group (C), 6 males and 4 females, aged 5.9 +/- 2.7, received the same volume of normal saline instead of ulinastatin. Arterial blood samples were taken before CPB (T1), at release of the aortic cross-clamp (T2), 30 min after aortic release (T3), 4 h and 24 h after discontinuation of CPB (T4, T5) for determination of plasma levels of cardiac troponin I (cTnI), creatine phosphokinase (CK) and creatine phosphokinase isoenzyme (CK-MB).
The CPB time, aortic cross-clamping time and duration of operation were comparable between these 2 groups. The plasma cTnI level and CK and CK-MB activities were all within normal range before CPB in both groups. In group C the plasma level of cTnI started to increase at T2, peaked at T4 and started to decrease at T5. In group U the plasma levels of cTnI at T3 and T4 were significantly higher than the baseline value (both P<0.01) and returned to the baseline value at T5. The plasma cTnI levels at T(3-5) were significantly lower in group U than in group C (all P<0.01). The plasma CK and CK-MB activities increased significantly at T(2-5) in both groups (all P<0.01). There was no significant difference in plasma CK and CK-MB activity at T(2-4) between the two groups, but at T5 their activities were significantly lower in group U than in group C (P<0.05). The rate of spontaneous recovery of heart beat without defibrillation was higher in group U (8/10) than in group C (4/10) (P<0.05). The drainage volume during the 24 hours after operation was greater in group C than in group U (P<0.05).
Ulinastatin effectively protects myocardium from ischemia-reperfusion injury during open heart surgery with CPB.
探讨乌司他丁对体外循环（CPB）下心内直视手术中心肌缺血-再灌注损伤的保护作用。
将20例接受CPB下行房间隔修补术或室间隔缺损修补术的美国麻醉医师协会（ASA）I-II级患者随机分为两组，每组10例。乌司他丁组（U组）共10例患者，男5例，女5例，年龄6.7±2.6岁，于主动脉插管前10分钟静脉注射乌司他丁12000单位/千克，剂量的一半于主动脉插管前10分钟静脉注射，另一半加入预充液中。对照组（C组）共10例患者，男6例，女4例，年龄5.9±2.7岁，给予相同体积的生理盐水代替乌司他丁。分别于CPB前（T1）、主动脉阻断解除时（T2）、主动脉阻断解除后30分钟（T3）、CPB停止后4小时和24小时（T4、T5）采集动脉血样，测定血浆心肌肌钙蛋白I（cTnI）、肌酸磷酸激酶（CK）及肌酸磷酸激酶同工酶（CK-MB）水平。
两组患者的CPB时间、主动脉阻断时间及手术时间相近。两组患者CPB前血浆cTnI水平、CK及CK-MB活性均在正常范围内。C组血浆cTnI水平于T2开始升高，T4达峰值，T5开始下降。U组T3及T4时血浆cTnI水平显著高于基础值（均P<0.01），T5时恢复至基础值。U组T(3-5)时血浆cTnI水平显著低于C组（均P<0.01）。两组患者T(2-5)时血浆CK及CK-MB活性均显著升高（均P<0.01）。两组患者T(2-4)时血浆CK及CK-MB活性差异无统计学意义，但T5时U组显著低于C组（P<0.05）。U组自主恢复心跳（未行除颤）的比例高于C组（8/10比4/10）（P<0.05）。术后24小时C组引流量多于U组（P<0.05）。
乌司他丁可有效保护CPB下心内直视手术中心肌免受缺血-再灌注损伤。
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