Yu Xiang-you, Fan Li-li
Intensive Care Unit, the First Affiliated Hospital of Xinjiang Medical University, Urumchi 830054, Xinjiang, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2009 Nov;21(11):664-7.
To evaluate the effect of ulinastatin (UTI) on the changes in inflammatory cytokines and inflammatory response as a result of cardiopulmonary bypass (CPB) in cardiac valvular replacement surgery and to investigate the protective effect of UTI on lungs.
A prospective randomized control clinical trial was designed, and 42 patients scheduled for elective cardiac valvular replacement were randomly divided into three groups: control group, UTI 8 kU/kg group (group U1) and UTI 12 kU/kg group (group U2), with 14 patient in each group. Blood samples were obtained from central vein for determination of plasma tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and IL-10 concentrations before operation (T1), 1 hour (T2), 4 hours (T3), and 24 hours (T4) after CPB respectively. At the same time points, arterial blood gas analysis were recorded for calculation of oxygen index (PaO2/FiO2) and respiratory index (RI).
(1)There was no significant difference in the plasma concentrations of TNF-alpha, IL-6 and IL-10 at T1 among the three groups (all P>0.05), but increased at T2-4 as compared with the T1 in three group (P<0.05 or P<0.01). Compared with the control group, the plasma level of TNF-alpha and IL-6 of both UTI groups at T2-4 were significantly lower, IL-10 of both UTI groups was significantly higher, and changes were more marked in group U2 than those in group U1 (P<0.05 or P<0.01). (2) There was no significant difference in PaO2/FiO2 and RI at T1 among the three groups (all P>0.05), but PaO2/FiO2 was decreased, RI was increased at T2-4 as compared with the T1 in three group (P<0.05 or P<0.01). Compared with the control group, the PaO2/FiO2 of the two UTI groups was significantly higher, the RI of the two UTI groups was lower at T2-4, and changes were more marked in group U2 than those in group U1 (P<0.05 or P<0.01).
During the CPB, UTI can significantly inhibit the inflammatory cytokine release and reduce the inflammatory response, lessen the lung inflammatory response to CPB and protect lung function, the effect of UTI shows a dose-effect relationship.
评价乌司他丁（UTI）对心脏瓣膜置换手术中体外循环（CPB）所致炎症细胞因子变化及炎症反应的影响，探讨UTI对肺的保护作用。
设计前瞻性随机对照临床试验，将42例择期行心脏瓣膜置换术的患者随机分为三组：对照组、UTI 8 kU/kg组（U1组）和UTI 12 kU/kg组（U2组），每组14例。分别于术前（T1）、CPB后1小时（T2）、4小时（T3）和24小时（T4）从中心静脉取血测定血浆肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）和IL-10浓度。同时记录各时间点动脉血气分析结果，计算氧合指数（PaO2/FiO2）和呼吸指数（RI）。
（1）三组T1时血浆TNF-α、IL-6和IL-10浓度比较差异无统计学意义（均P>0.05），但三组T24时均较T1时升高（P<0.05或P<0.01）。与对照组比较，UTI两组T24时血浆TNF-α和IL-6水平均显著降低，UTI两组IL-10水平均显著升高，且U2组变化较U1组更明显（P<0.05或P<0.01）。（2）三组T1时PaO2/FiO2和RI比较差异无统计学意义（均P>0.05），但三组T24时PaO2/FiO2较T1时降低，RI较T1时升高（P<0.05或P<0.01）。与对照组比较，UTI两组T24时PaO2/FiO2显著升高，RI降低，且U2组变化较U1组更明显（P<0.05或P<0.01）。
CPB期间，UTI可显著抑制炎症细胞因子释放，减轻炎症反应，减轻肺对CPB的炎症反应，保护肺功能，其作用呈剂量效应关系。
