乌司他丁对体外循环心脏手术患者TXA２及PGI２影响.doc

乌司他丁对体外循环心脏手术患者TXA２及PGI２影响 　 作者：林学正 周春莲 林仙菊 【摘要】 目的 观察乌司他丁(UTI)对体外循环(CPB)心脏手术患者血栓素(TXA２)和前列环素(PGI２)的影响。 方法 将60例CPB择期心脏手术患者随机分为实验组和对照组，分别采用UTI 1.2万U/kg稀释于10m1生理盐水中和等量生理盐水中，一次性加入CPB预充液中，分别于麻醉诱导后(T1)、主动脉开放30min(T2)、术毕(T3)及术后6h(T4)4个时点，抽取桡动脉血用放射免疫法测定TXB2/6-keto-PGF１α浓度。 结果 CPB后两组患者T2、T3、T4血浆TXB2、TKG 6-keto-PGF１α浓度均较T１浓度增加(Plt;0.05)，但实验组增加幅度低于对照组(Plt;0.05)，且术后6h TXB2、6-keto-PGF１α浓度己降到或低于术前水平(Plt;0.05)。 结论 血浆TXA２和PGI２比值升高，可能是CPB后肺损伤的机制之一。乌司他丁对CPB后肺损伤的保，护作用可能与改善花生四烯酸代谢紊乱，抑制TXA２/PGI２比值升高有关。 【关键词】 乌司他丁 体外循环 肺损伤 血栓素 前列环素 　　【Abstract】 Objective To study the effect of ulinastatin on thromboxane A2(TXA2) and prostaglandin I2(PGI2) in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods Sixty patients undergoing cardiac surgery with CPB were randomly divided into two groups. In experimental group，1.2×104 U/Kg of Ulinastatin was added to the CPB priming solution, replaced by the same volume normal saline in control group. Radical artery blood sample were taken for determination of thromboxane B2(TXB2) and 6-kete-prostaglandin F1α(6-keto-PGF1α)by radioimmunity after induction of anesthesia(T1)，30min after release of aortic cross-clamp(T2), end of operation(T3) and 6h after operation(T4). Results: Compared with T1, plasma levels of TXB2、6-keto-PGF1α and TXB2/6-keto-PGF1α in both groups were increased significantly at T2, T3 and T4 (Plt;0.05). and plasma levels of TXB2、6-keto-PGF1α and TXB2/6-keto-PGF1α in control group was higher than that in experimental group(Plt;0.05). Conclusion Changes of plasma levels of TXA2/PGI2 may be in charge of acute lung injury after CPB. Ulinastation could inhibit the increase of TXA2/PGI2 and may be benefit to respiration function in patients undergoing cardiac surgery with cardiopulmonary bypass. 　　【Key Words】 Ulinastatin Cardiopulmary bypass Lung injury Thromboxane A2 Prostaglandin I2 　　 体外循环(CPB)术后肺损伤一直是心血管外科研究的难点之一。全身炎性反应(SIRS)是CPB后诱发急性肺损伤发生的主要机制［１］，而血栓素(TXA２)和前列环素(PGI2)作为体内重要的炎性因子，参与了CPB后急性肺损伤［２］。乌司他丁(UTI)是一种高效广谱的蛋白酶抑制剂，对多