文章摘要
魏 磊,刘 标,梁永年,陈亦江,陈 亮,吴延虎.乌司他丁在体外循环中肺保护机制的研究[J].南京医科大学学报,2008,28(4):540~544
乌司他丁在体外循环中肺保护机制的研究
The protective effects of Ulinastatin on pulmonary tissue during cardiopulmonary bypass
投稿时间:2007-11-11  
DOI:10.7655
中文关键词: 乌司他丁  体外循环  肺保护  肺损伤
英文关键词: Ulinastatin  cardiopulmonary bypass  pulmonary protect  lung injury
基金项目:
作者单位
魏 磊 南京医科大学第一附属医院胸心外科江苏 南京 210029 
刘 标 南京医科大学第一附属医院核医学科江苏 南京 210029 
梁永年 南京医科大学第一附属医院胸心外科江苏 南京 210029 
陈亦江 南京医科大学第一附属医院胸心外科江苏 南京 210029 
陈 亮 南京医科大学第一附属医院胸心外科江苏 南京 210029 
吴延虎 南京医科大学第一附属医院胸心外科江苏 南京 210029 
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中文摘要:
      目的:探讨体外循环所引起的肺组织炎性损伤,研究术中应用乌司他丁(UTI)对肺的保护作用及可能的机制。方法:25例患者随机分为两组,实验组将乌司他丁2万U/kg于体外循环开始后,直接加入体外循环机中;对照组除用等量生理盐水替代乌司他丁外,其他条件相同。动态检测两组患者左右房中性粒细胞数(polymorphonuclear neutrophils,PMN)、血小板数(Pt);血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-?琢(TNF-a)水平;气道压力、肺泡氧合指数(OI)。结果:①对照组主动脉开放心脏复跳后5 min左房PMN、Pt明显低于右房(P < 0.05);②体外循环(cardiopulmonary bypass,CPB)开始后,两组桡动脉血IL-6、TNF-?琢进行性升高,于主动脉开放心脏复跳后达最高,后逐渐下降,但仍高于CPB前,对照组增高更显著(P < 0.05)。③CPB开始后,两组桡动脉血IL-10进行性增高,于主动脉开放心脏复跳后,达到最高,后逐渐下降,但仍高于CPB前,实验组增高更显著(P < 0.05)。④两组患者肺泡氧合指数(OI)CPB后比麻醉诱导时增高,对照组升幅明显高于实验组(P < 0.05)。⑤两组气道峰压、气道平台压在停CPB和手术结束后均有升高,但对照组升高更显著(P < 0.05),且对照组与实验组有显著差异(P < 0.05)。结论:乌司他丁能通过抑制血小板、中性粒细胞的激活、肺内聚集和扣留,抑制炎症因子IL-6、TNF-?琢的产生,并能促进抗炎因子IL-10的释放,从而减轻体外循环后肺损伤和通气功能障碍,保护并改善术后肺功能。
英文摘要:
      Objective:To evaluate the protection of Ulinastatin(UTI)on pulmonary tissue during cardiopulmonary bypass(CPB). Methods:Twenty-five patients undergoing open-heart surgery under CPB were evaluated in this study. The patients were randomly divided into two groups:control group and experimental group. The experimental group received Ulinastatin as the way of pulmonary protection. Polymorphonuclear neutrophils(PMN) and platelet(Pt) count,interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-a (TNF-a),alveolar oxygenation index(OI),airway peak pressure and plateau pressure were recorded perioperatively between two groups. Results:The changes of PMN and Pt count in the right atrium blood were significantly higher than that in the left one on 5 min after aorta declamped in control group(P < 0.05). The plasma levels of IL-6 and TNF-a in experimental group were significantly lower than that of the control group(P < 0.05). IL-10 in experimental group increased compared with control group(P < 0.05). OI,airway peak pressure and plateau pressure in control group was significantly higher(P < 0.05) than that of experimental group. Conclusion:Our results demonstrated that PMN and Pt could aggregate in the pulmonary,and IL-6,TNF-a,IL-10 could play an important role in lung injury in CPB. The Ulinastatin could protect pulmonary during cardiopulmonary bypass.
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