乌司他丁心脏停搏液对心肌损伤的保护作用

摘要

目的 观察含乌司他丁的心脏停搏液是否对体外循环下的心肌具有保护作用.方法 随机选择40例房间隔缺损或室间隔缺损的先天性心脏病患者分为乌司他丁组(U组)和对照组(C组)各20例,U组的心脏停搏液为含乌司他丁5 000 U/kg的St'Thomas停搏液,C组为单纯的St.Thomas停搏液.分别于诱导前、主动脉开放后即刻及术毕、术后6 h、术后24 h和术后48 h检测肌酸激酶同工酶MB(CKMB)、肌钙蛋白I(cTnI)、肿瘤坏死因子-α(TNF-α)、白介素6(IL-6)和血浆丙二醛(MDA)及超氧化物歧化酶(SOD).记录患者主动脉开放后心脏复苏及血管活性药物的使用情况以及ICU的停留时间.结果 两组患者体外循环时间及主动脉阻断时间无统计学差异(P>0.05).U组的并行循环时间和心脏自动复跳率与C组有显著差异 (P<0.05),但两组患者在ICU的停留时间无显著差异(P>0.05).两组患者诱导前的各项指标均无显著差异(P>0.05);主动脉开放后CKMB、cTnI、TNF-α和IL-6及MDA均较基础值显著增高,SOD则明显降低(P<0.05),且在手术结束时达峰值,但U组仍与C组有差异(P<0.05).U组多巴胺的平均使用剂量显著少于对照组(P<0.05),两组患者去甲肾上腺素的使用剂量则无差异(P>0.05),数据相关分析显示手术结束即刻TNF-α和IL-6均与CKMB呈显著正相关(P<0.05),IL-6与cTnI也呈显著正相关(P<0.05),SOD与CKMB和cTnI均呈显著负相关(P<0.05),而MDA只与CKMB呈显著正相关 (P<0.05).结论 乌司他丁通过减轻全身炎症反应和氧自由基的损伤,减轻心肌细胞的损伤,降低了心功能不全的发生率.%Objective To investigate the effect of Ulinastatin eardioplegia solution against myocardial injury during extracorpo-real circulation. Methods 40 patients suffered congenital heart disease ( ASD or VSD ) were randomly divided into Ulinastatin ( U ) group and contra! ( C ) group. U group patients were treated with StThomas cardioplegia solution mixed with Ulinastatin ( 5000 U/kg) while C group patients were only given St Thomas cardioplegia solution. CKMB, cTnl, TNF — a, IL — 6, MDA and SOD were detected before induction and after aorta opening and they were also detected 0, 6 h, 24 h and 48 h after surgery. Heart recovery time, use of vasoactive agent and length of stay were recorded. Results There were no difference in extracorporeal circulation time and aorta interrupted time between the two groups, so was their length of stay. Automatic heart recover rate was higher in U group. Plasma concentration of CKMB, cTnl, TNF —α, IL — 6 and MDA were increased after aorta opening while SOD was obviously decreased, and all of these indexes reached their peak concentration at the end of surgery. Maximal dose of dopamine using of U group was significantly lower than C group while with no difference in noradrenaline. Data correlation analysis showed that there were positive relationship between TNF-α, IL-6 and CKMB, IL-6 and cTnl, MDA and CKMB. Negative relationship was detected between SOD, CKMB and cTnl. Conclusion Ulinastatin decreased cardiac myocyte injury and cardiac dysfunction by alleviating systemic inflammatory reaction and oxygen radicals injury.