乌司他丁在经皮体外循环中对犬心肌保护作用的试验研究阳世雄1.DOC

乌司他丁在经皮体外循环中对犬心肌保护作用的实验研究 阳世雄1 刘庆远1 曾建业2 韦涌初1 黄思光1卢苇1 潘小明1 摘 要 目的 研究乌司他丁(Ulinastatin，UTI)应用于经皮体外循环（Percutaneous cardiopulmonary support system，PCPS）中对犬心肌组织中细胞间黏附分子-1（Intercellular adhesion molecule，ICAM-1）表达的影响及其对心肌的保护作用。 方法 试验用杂种犬20只，随机平均分为乌司他丁实验组（U组）和对照组（C组），每组各10只。U组在PCPS预充液中加1万U/ kg UTI ,并于PCPS转机开始前即经静脉再给1 万U/ kg UTI持续滴注。C组常规建立PCPS并转机。分别于PCPS转机前10 min（A时点）和PCPS转机后60 min（B时点）两个时点，切取犬心肌右心耳组织，检测心肌组织ICAM-1表达量及心肌组织中超氧化物歧化酶（Superoxide dismutase，SOD）、丙二醛（Maleic dialdehyde，MDA）、乳酸（Lactic acid，LA）、三磷酸腺苷酶（Adenosine triphosphate，ATPase）的水平。并记录PCPS建立时间、主动脉阻断时间、主动脉灌注时间、经皮体外循环转机时间、心脏复跳情况。 结果 两组实验犬心肌组织中，ICAM-1的表达量在B时点较A时点均明显增高，但在B时点 U组ICAM-1表达量低于C组（P0.05）； LA 和MDA 的含量在B时点均明显高于A时点，但在B时点U组LA和MDA的含量均低于C组（P0.05）；SOD和ATPase的活力在B时点均低于A时点，但在B时点U组SOD和ATPase的活力高于C组（P0.05）。结论 PCPS时，心肌组织的缺血-再灌注损伤可引起心肌组织ICAM-1 表达上调，心肌组织中 LA和MDA含量增高，SOD和ATPase活力降低。应用乌司他丁可抑制心肌组织中ICAM-1的表达，减少心肌组织中LA和MDA 的产生，降低SOD和ATPase的消耗，从而减轻心肌的炎症反应，进而保护心肌组织。 关键词 乌司他丁；经皮体外循环；心肌保护；细胞间黏附分子-1 EFFECTS OF ULINASTATIN ON CANINE MYOCARDIAL INJURY IN PERCRTANEOUS CARDIOPULMONARY SUPPORT SYSTEM ABSTRACT Objective To investigate the expression of intercellular adhesion molecule-1(ICAM-1) in canine myocardium during the PCPS, evaluate whether ulinastatin could influence its expression and the protective effect on myocardium. Methods Twenty dogs were randomly and medially divided into two groups: ulinastatin group（UG） and ontrol group (CG)。In ulinastatin group (U n =10) dogs received ulinastatin 20000 unit·kg-1, half was added into the PCPS priming fluid, and another half was given intravenous injection before PCPS running. In control group(C n=10) dogs received PCPS conventionally, the same volume of saline instead of ulinastatin. Right atrial appendage of the dog was obtained by the time of 10 minitures before PCPS running (point A) and 60 minitures after PCPS running (point B). The expression of ICAM-1 in cardiac myocytes and the levels of SOD、MDA、LA、ATP in canine myocardium were detected. And meantime we recorded the establi