摘要
目的探讨不同剂量乌司他丁对体外循环术后患者肺功能的保护作用。方法回顾性分析我院2010年2月-2014年12月,90例体外循环下实施先天性心脏病手术矫治患者临床资料,按照随机抛硬币法分组为对照组、甲组、乙组,各30例,其中对照组采用与甲乙两组等容量的生理盐水;甲组采用0.8万U/kg乌司他丁;乙组采用1.2万U/kg乌司他丁。分别于麻醉诱导后切皮前(T_1)、停止体外循环后1 h(T_2)、4h(T_3)及24 h(T_4)时抽取其静脉血液以检测血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)及细胞间粘附分子-1(sICAM-1)浓度;同时记录T_1、T_2、T_3、T_4时动脉血气、呼吸功能等指标,并计算肺动态顺应性(Cd)、呼吸指数(RI)、氧合指数(OI)级肺静态顺应性(Cs)。结果 3组患者于T_1时的各项炎症因子浓度及呼吸功能指标比较,P>0.05;甲、乙两组于T_3、T_4时TNF-α、IL-6及sICAM-1浓度较对照组明显下降,而OI和Cs及Cd明显增大,RI值明显减少,P<0.05;甲、乙两组于T_2、T_3时IL-10浓度较对照组明显升高。乙组于T_3、T_4时TNF-α、IL-6及sICAM-1浓度较甲组低,而IL-10浓度较甲组高,OR值增加且RI值减少,P<0.05;乙组于T_2、T_3时Cs及Cd值较甲组明显增加,P<0.05。结论所有患者均于体外循环期间发生炎症反应,同时应用不同剂量乌司他丁可起到炎症因子抑制作用,从而减轻患者肺功能损伤,有利于改善患者术后肺功能,且剂量高的保护效果更理想。
Objective To investigate the protective effect of different doses of ulinastatin on lung function af- ter cardiopulmonary bypass. Methods The clinical data of 90 patients undergoing cardiac valve replacement from February 2010 to December 2014 under cardiopulmonary bypass were retrospectively analyzed. They were randomly divided into the control group, the group A and the group B, 30 cases in each group. The control group was given e- qual volume of saline, the group A was given 8000 U/kg ulinastatin, and the group B with 12,000 U/kg ulinastatin. Their plasma tumor necrosis factor-or （TNF-α） , interleukin -6 （IL-6）, interleukin -10 （IL-10）, adhesion mole- cule-1 （ sICAM-1 ） and intercellular concentrations were detected before induction of anesthesia Houqie Pi （T1）, af- ter the cessation of CPB 1 h （T2）, venous blood drawn 4h （T3） and 24 h （T4）. Their arterial blood gas, respirato- ry function and other indicators were recorded, and the dynamic lung compliance （ Cd）, respiratory index （ RI）, ox- ygenation index （OI） and static lung compliance （Cs） were calculated. Results There was no significant difference in the concentration of inflammatory cytokines and respiratory function parameters among the three groups at T1 （P 〉 0.05）. The levels of TNF-α, IL-6 and sICAM-1 decreased more significantly, and the value of OI, Cs and Cd in- creased more significantly in the group A and B than in the control group at T3 and T4 （ P 〈 0.05）. The IL-10 con- centration was significantly higher in the group A and B than in the control group at T2 and T3. The level of TNF-α, IL-6 and sICAM 1 was relatively lower in the group B than in the group A, and IL-10 concentration was higher in the group B than in the Group A at T3 and T4. OR value increased and RI decreased more obviously in the group B than in the group A （ P 〈 0. 05）. The value of Cs and Cd increased more significantly in the group B than in the group A at T2 and T3 （P 〈 0.05）. Conclusion Protecti
作者
景小勇
杨学勇
陈哲
刘迎龙
JING Xiao- yong YANG Xue-yong CHEN Zhe LIU Ying-long(Department of Pediatric Cardiac Surgery, Anzhen Hospital Affili- ated to Capital Medical University, Beijing 100029, China)
出处
《临床肺科杂志》
2017年第3期493-496,共4页
Journal of Clinical Pulmonary Medicine
关键词
乌司他丁
体外循环
肺功能
炎症因子
肺功能
UTI
cardiopulmonary bypass
pulmonary function
inflammatory factors
lung function
