乌司他丁对体外循环冠状动脉搭桥术围手术期炎症反应的影响

[Effect of ulinastatin on perioperative inflammatory response to coronary artery bypass grafting with cardiopulmonary bypass].

作者信息

Zhou Qi, Wang Gang, Gao Changqing, Chen Tingting

机构信息

Department of Cardiovascular Surgery, General Hospital of the PLA, Beijing 100853, China.

出版信息

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2010 Feb;35(2):107-10. doi: 10.3969/j.issn.1672-7347.2010.02.003.

DOI:10.3969/j.issn.1672-7347.2010.02.003

PMID:20197607

Abstract

OBJECTIVE

To determine the effect of ulinastatin on perioperative inflammatory response to coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).

METHODS

Forty patients undergoing CABG with CPB were randomly divided into 2 groups: a ulinastatin group (1.5 10(4) U/kg before CPB, n=20) and a control group (n=20). The inflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-6, IL-10 and neutrophil elastase (NE) were measured before the anesthesia (T1), 1 h after the start of CPB (T2), 1 h after weaning of CPB (T3), and 24 h after weaning of CPB (T4). The postoperative organ dysfunction in the 2 groups was noted.

RESULTS

The concentration of TNF-alpha, IL-6, IL-10, and NE at T2,T3, and T4 and increased more significantly than that at T1 in the 2 groups(P<0.05). The concentration of TNF-alpha, IL-6 and NE at T2, T3, and T4 in the ulinastatin group decreased more significantly than that in the control group (P<0.05), and IL-10 in the ulinastatin group increased at the same time. The postoperative complications of pneumonia, kidney and central nervous system in the ulinastatin group decreased more significantly than that in the control group (P<0.05). There was no significant difference in the postoperative cardio or liver complications and hours in the ICU between the 2 groups.

CONCLUSION

Administration of ulinastatin before CPB can decrease the inflammatory response and complication during CABG.

摘要

目的

确定乌司他丁对体外循环（CPB）下行冠状动脉旁路移植术（CABG）围手术期炎症反应的影响。

方法

40例行CPB下CABG的患者随机分为2组：乌司他丁组（CPB前给予1.5×10⁴U/kg，n = 20）和对照组（n = 20）。于麻醉前（T1）、CPB开始后1小时（T2）、CPB停机后1小时（T3）及CPB停机后24小时（T4）测定肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-6、IL-10和中性粒细胞弹性蛋白酶（NE）等炎症细胞因子。记录两组术后器官功能障碍情况。

结果

两组T2、T3及T4时TNF-α、IL-6、IL-10和NE浓度较T1时均显著升高（P<0.05）。乌司他丁组T2、T3及T4时TNF-α、IL-6和NE浓度较对照组下降更显著（P<0.05），同时乌司他丁组IL-10升高。乌司他丁组术后肺炎、肾脏及中枢神经系统并发症较对照组下降更显著（P<0.05）。两组术后心脏或肝脏并发症及在重症监护病房的时间无显著差异。