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乌司他丁对心脏手术患者气道氧化应激及肺功能的影响

Effects of ulinastatin on airway oxidative stress and pulmonary function in patients undergoing cardiac surgery

    摘要
  • 摘要:
    目的 探讨乌司他丁对心脏手术患者气道氧化应激及肺功能的影响。
    方法 选取择期行体外循环下心脏瓣膜置换术的42例患者作为研究对象, 采用随机抽样法分为乌司他丁组和对照组，每组21例。乌司他丁组将15 000 IU/kg乌司他丁加入体外循环预充液中，对照组加入同等量生理盐水。分别于气管插管后即刻(T0)、停体外循环后即刻(T1)、开始关胸(T2)和术后4 h(T3)收集呼出气冷凝液并检测8-异前列腺素F2α(8-isoPGF2α)浓度，记录患者每次采集呼出气冷凝液时的吸入气氧浓度(FiO2)、潮气量(VT)等指标并行血气分析，计算氧合指数、肺泡-动脉血氧分压差pA-a(O2)和呼吸指数(RI)。术后随访观察患者的气管导管拔管时间、重症监护时间、术后住院时间和术后肺部并发症(PPCs)、其他不良反应发生情况。
    结果 2组患者呼出气冷凝液中8-isoPGF2α水平在停止体外循环后均升高，且乌司他丁组T1、T2、T3时点呼出气冷凝液中8-isoPGF2α水平均低于对照组，差异有统计学意义(P < 0.05)。乌司他丁组T1、T2、T3时点氧合指数高于对照组, T1、T2时点pA-a(O2)低于对照组, T2时点RI低于对照组，差异有统计学意义(P < 0.05)。乌司他丁组PPCs发生率为20.00%, 低于对照组的57.89%, 差异有统计学意义(P < 0.05)。乌司他丁组患者术后拔管时间早于对照组，重症监护时间短于对照组，差异有统计学意义(P < 0.05)。
    结论 乌司他丁可能通过减轻气道氧化应激而改善心脏手术患者氧合和肺功能，减少PPCs发生，缩短术后拔管时间和重症监护时间。

     

    Abstract:
    Objective To study the effect of ulinastatin on airway oxidative stress and pulmonary function in patients undergoing cardiac surgery.
    Methods A total of 42 patients who underwent elective cardiac valve replacement under extracorporeal circulation were selected, and were randomly divided into ulinastatin group and control group, with 21 patients in each group. The ulinastatin group was given 15 000 IU/kg ulinastatin to the preflush, while the same amount of normal saline was added in the control group. Exhaled breath condensate fluid was collected immediately after tracheal intubation (T0), immediately after cease of cardiopulmonary bypass (T1), chest closure (T2) and 4 h after operation (T3), and the concentration of 8-isoprostaglandin F2 alpha (8-isoPGF2α) was detected. The fraction of the oxygen in the inspired air (FiO2), tidal volume (VT) and other indicators were recorded and were performed blood gas analysis. The oxygenation index, alveolar artery oxygen partial pressure difference pA-a(O2) and respiratory index (RI) were calculated. Postoperative follow-up was performed to observe the extubation time of tracheal catheter, intensive care duration, postoperative hospital stay, the occurrence of postoperative pulmonary complications (PPCs) or other adverse reactions.
    Results The levels of 8-isoPGF2α in exhaled breath condensate fluid of both groups were significantly increased after cardiopulmonary bypass, and were significantly lower at T1, T2 and T3 in the ulinastatin group than those in the control group (P < 0.05). The oxygenation indexes at T1, T2 and T3 of the ulinastatin group were higher than that of control group, the levels of pA-a(O2) at T1 and T2 were lower than that of control group, and the RI at T2 was lower than that of control group, the differences were statistically significant (P < 0.05). The incidence of PPCs was 20.00% in the ulinastatin group, which was lower than 57.89% in the control group (P < 0.05). The time to postoperative extubation was earlier, and the time of intensive care was shorter than that of the control group (P < 0.05).
    Conclusion Ulinastatin may improve oxygenation and pulmonary function by reducing airway oxidative stress in patients undergoing cardiac surgery, reduce the occurrence of PPCs, and shorten the postoperative extubation time and intensive care duration.

     

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