乌司他丁对双瓣置换患者围术期溶酶体膜稳定性及凝血功能的影响

摘要

目的观察体外循环中应用乌司他丁对双瓣置换患者围术期溶酶体膜稳定性及凝血功能的影响。方法在体外循环下行二尖瓣联合主动脉瓣置换患者20例，随机分为乌司他丁组及对照组，乌司他丁组患者按20000 U/kg总量给予乌司他丁，其中半量预充，半量于主动脉开放前加入到体外循环管路中，对照组患者给予等量生理盐水。分别于术前30 min，体外循环60 min、120 min及体外循环结束后30 min采集血样，ELISA方法检测血浆中组织蛋白酶D（ CTSD）及N-乙酰-β-D-氨基葡萄糖苷酶（ NAG）含量；采用血栓弹力图比较手术前后凝血功能。同时，记录术后ICU滞留时间、引流量、24 h尿量及呋塞米用量，以及术后呼吸机辅助时间、死亡等情况。结果两组患者均顺利出院，无死亡，无严重并发症；术后ICU时间、机械通气时间、术后第1个24小时尿量及呋塞米用量组间无显著差异（ P＞0.05）；与对照组比较，凝血功能各项指标在手术结束后未见明显差异（ P＞0.05）；体外循环过程中各时间点NAG及CTSD含量组间无显著差异（ P＞0.05）。结论体外循环中应用乌司他丁20000 U/kg对双瓣置换患者围术期溶酶体稳定性及凝血功能的保护作用与对照组没有明显差异。%Objective To investigate the effects of ulinastatin on the stability of lysosomal membrane and blood coagulation functions in patients undergoing mitral and aortic valves replacement .Methods Twenty consecutive patients scheduled for mitral and aortic valve replacement surgery under cardiopulmonary bypass (CPB) were randomized into two groups:ulinastatin group , who received 20 000 U/kg ulinastatin during CPB with half added into the prime solution and half added to the circuit upon aortic clamping removal;control group , who received same volume of saline .Blood sample were collected at 30 min before the operation ,60 min and 120 min after the initiation of CPB ,and 30 min after the termination of CPB .Serum concentration of cathepsin D ( CTSD) and n-acetyl-β-glucosaminidase ( NAG) were measured with ELISA .Perioperative blood coagulation functions were examined with thrombelastogram .Post operative deaths and complications , ICU stay , mechanical ventilation time , drainage volume ,urine volume and furosemide usage during the first postoperative 24 h were also recorded .Results There was no death, no severe complications in both groups .The post operative parameters such as ICU stay , mechanical ventilation time ,urine volumes and furosemide usage during the first postoperative 24 h were similar between the two groups.Post operative blood coagulation functions were comparable between the two groups .Serial serum concentrations of CTSD and NAG were not significantly different between the two groups .Conclusions Compared with control,20 000 U/kg ulinastatin used during CPB has no significant effects on the lysosomal membrane stability and blood coagulation functions in patients undergoing mitral and aortic valves replacement .