氨溴索、乌司他丁对体外循环心脏手术患者肺功能的保护作用及机制

摘要

Objective To evaluate the protective effect of ambroxol and ulinastatin on pulmonary function in patients undergoing cardiac operation under cardiopulmonary bypass(CPB). Methods 40 patients who were undergoing valve replacement were divided into four groups randomizely; ambroxol group (groupA, n = 10) , ulinastatin group (group U, n = 10) , combination group (group AU, n = 10) and control group ( group C, n = 10). 5 ml radial artery blood was drawn on each of the five time point: T, ( before CPB) , T2 (termination of CPB) , T3 ( 2 h after CPB) , T4 (4 h after CPB) , T5 (18 h after CPB). Plasma IL-6, IL-8, IL-10, TNF-a, blood gas, oxygenation index (01) and respiratory index (RI) were detected at these time-points. Results In all groups, the plasma levels of IL-6, IL-8, IL40 and TNF-a increased after CPB and reach to the top levels at a short time, and then deceased by degrees, all P <0.05. Among them, the plasma leves of IL-6, IL-8 and TNF-a did not drop to nomal in 18 h after CPB. Compared with the control group, patients in the U group and AU group had a lower plasm level of IL-6, IL-8, IL-10 and TNF-a after CPB (all P < 0. 05) , the effects were more manifest in the All group. In all groups, OI and RI at time-points after CPB were significantly higher than those before CPB, The extent of increase in AU group was lower than those in the other groups ( all P < 0.05 ). Conclusion Both ambroxol and ulinastatinhas can effectively inhibit the release of the inflammatory cytokines and have protective effects on pulmonary function in patients undergoing cardiac operation under cardiopulmonary bypass.%目的 观察氨溴索、乌司他丁对体外循环(CPB)心脏手术患者肺功能的保护作用,并探讨其机制.方法 40例CPB下行瓣膜置换手术患者,随机分为氨溴索组(A组)、乌司他丁组(U组)、联合组(AU组)和对照组(C组),每组10例.A组麻醉诱导后静脉滴注氨溴索0.5 mg/kg,U组在CPB过程中予1万U/kg乌司他丁,AU组联合应用上述两种药物；C组均未应用氨溴索及乌司他丁.分别在CPB前(T1)、CPB停止(T2)、CPB结束后2h(T3)、CPB结束后4 h(T4)及CPB结束后18 h(T5)采集桡动脉血,测定血清白介素-6(IL-6)、白介素-8(IL-8)、白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α),并通过血气分析计算呼吸指数(RI)和肺氧合指数(OI).结果 四组患者CPB后RI和OI较CPB前均有不同程度升高(P均＜0.05)；CPB后各时点A、U、AU组患者RI、OI均明显低于C组,AU组RI、OI明显低于其他3组(P均＜0.05).四组患者血清中IL-6、IL-8、IL-10、TNF-α水平在T2开始升高并很快达到峰值,后逐渐下降,IL-6、IL-8和TNF-a直到术后18h仍未降至术前水平(P均＜0.05).与C组相比,CPB结束后各时点U组、AU组患者血清中IL-6、IL-8、IL-10、TNF-α水平明显减低(P均＜0.05),AU组降低更加明显(P均＜0.05).结论 氨溴索、乌司他丁均可对CPB心脏瓣膜置换手术患者围术期肺功能起到保护作用.乌司他丁的肺保护作用与其抑制炎症因子的释放有关,从而减轻肺功能损伤,保护并改善术后肺功能.