摘要
目的 观察乌司他丁对先天性心脏病心内直视手术围体外循环期 (CPB)心肌再灌注损伤的防护作用。方法 2 0例房间隔缺损或室间隔缺损修补术患者 ,随机分为对照组 (C组 )与乌司他丁组 (U组 ) ,每组 10例。于体外转流前 (T1)、开放主动脉即刻 (T2 )、开放主动脉 30min (T3 )、停止CPB4h (T4)和 2 4h(T5)抽取动脉血 ,测定血浆CK MB、CK活性及心肌肌钙蛋白I(cTnI)浓度。记录CPB转机时间、主动脉阻断时间、手术时间、围CPB期间心血管活性药物的使用情况、心脏复跳情况以及术后 2 4h引流量。结果 两组患者术前血浆cTnI浓度及CK、CK MB活性均在正常范围内 ,组间比较差异无显著意义。C组血浆cTnI浓度在T3 、T4和T5时间点显著升高 (P <0 0 1) ,于T4时点达峰值 ,T5时点开始下降。U组血浆cTnI浓度在T3 、T4时点显著升高 (P <0 0 1) ,于T5时间点已下降至正常水平。在T3 ～T5时间点U组cTnI水平明显低于C组 (P <0 0 1)。C组与U组血浆CK和CK MB活性在T2 ～T5时点都显著升高 (P <0 0 1) ,T2 ～T4时点两组比较差异无显著意义 ,至T5时点U组显著低于C组(P <0 0 5 ) ,U组自动复跳率多于C组 (P <0 0 5 )。术后 2 4h引流量C组明显多于U组 (P <0 0 5 )。结论 围CPB期间分两次使用乌司他丁 1 2万U/kg 。
Objective To investigate the protective effect of ulinastatin on myocardium against ischemia-reperfusion injury in open heart surgery with cardiopulmonary bypass (CPB). Methods 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 (T_1), at release of the aortic cross-clamp (T_2), 30 min after aortic release (T_3), 4 h and 24 h after discontinuation of CPB (T_4, T_5) for determination of plasma levels of cardiac troponin I (cTnI), creatine phosphokinase (CK) and creatine phosphokinase isoenzyme (CK-MB). Results 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 T_2, peaked at T_4 and started to decrease at T_5. In group U the plasma levels of cTnI at T_3 and T_4 were significantly higher than the baseline value (both P <0.01) and returned to the baseline value at T_5. 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 T_5 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). Conclusion Ulinastatin effectively protects myocardium from ischemia-reperfusion injury during open heart surgery with CPB.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2003年第16期1391-1393,共3页
National Medical Journal of China
