乌司他丁在体外循环中肺保护机制探究.docVIP

乌司他丁在体外循环中肺保护机制探究 　 作者：魏磊　刘标，梁永年，陈亦江，陈亮，吴延虎 【摘要】 目的 探讨体外循环（cardiopulmonary bypass,CPB）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，实验组于转流后将UTI加入体外循环机中。动态检测两组患者左、右房中性粒细胞数(polymorphonuclear neutrophils，PMN)、血小板数(Plt)；血清白细胞介素- 6（IL- 6）、白细胞介素-10（IL-10）、肿瘤坏死因子- α（TNF- α）水平；肺顺应性；CPB后肺组织电镜检查变化结果。结果 ① 对照组心脏复跳后左房PMN、Pt明显低于右房（Plt;0.05）；② CPB开始后，两组桡动脉血IL-6、TNF-α进行性升高，心脏复跳后逐渐下降，对照组增高更显著（Plt;0.05）。③ CPB开始后，两组桡动脉血IL-10进行性增高，心脏复跳后逐渐下降，实验组增高更显著（Plt;0.05）。④ 肺顺应性在停CPB后均降低，对照组降低更显著，与实验组比较有显著差异（Plt;0.05）。⑤ 电镜观测：实验组 Ⅰ型、Ⅱ型肺泡细胞内细胞器、细胞形态学的改变较轻。结论 UTI能减轻CPB后肺损伤，保护术后肺功能。 【关键词】 乌司他丁；体外循环；肺保护；肺损伤 Abstract: OBJECTIVE To evaluate the protection of Ulinastatin (UTI) on pulmonary tissue during cardiopulmonary bypass(CPB). METHODS 25 patients undergoing open-heart surgery with CPB were evaluated in this study. The patients were randomly divided into two groups:　control group and experimental group. The experimental group received UTI as the way of pulmonary protection. Polymorphonuclear neutrophils (PMN) and platelet (Plt) count, interleukin-6(IL-6), IL-10, tumor necrosis factor-α(TNF-α), lung compliance and the histological examination under electron microscopy of the lung were recorded perioperatively. RESULTS The changes of PMN and Plt count in the right atrium blood were significantly higher than that in the left one after aorta declamp off in control group(Plt;0.05). The plasma levels of IL-6 and TNF-α in experimental group were significantly lower than that of the control group (Plt;0.05) . IL-10 in experimental group increased compared with control group (Plt;0.05). Lung compliance decreased significantly in control group. The histological examination of the lung confirmed that the degree of lung injury was significantly decreased in experimental group. CONCLUSION Our results demonstrated that the Ulinastatin could protect pulmonary tissue during CPB. Key words： Ulinastatin；Cardiopulmonary bypass；Pulmonary protect；Lung injury 体外循环（cardiopulmonary bypass，CPB）诱发全身炎症反应（systemic i