【摘要】 目的　观察体外循环 (CPB)心脏手术后肺功能受损的程度 ,研究乌司他丁 (Ulinastatin ,UTI)对体外循环心脏手术肺功能的影响。方法　择期行心脏瓣膜置换术病人 6 0例 ,随机分成对照组 (I组 ,2 0例 ) ,UTI 1万U kg组 (II组 ,2 0例 ) ,UTI 2万U kg组 (III组 ,2 0例 )。对术后肺功能指标OI、VD VT、PA -aO2 、CaO2 、SaO2 和PaO2 进行观察以及比较呼吸机支持的时间 ,气管插管拔除后 2 4h内的自主呼吸频率和呼吸情况的改变。结果　I组术后各时点所有病人OI、VD VT、PA -aO2 分别较CPB前增大 (P <0 0 5 ) ,而CaO2 、SaO2 和PaO2 均下降 (P <0 0 5 )。术后各时点III组的OI值均明显低于I、II组 (P <0 0 5 ) ;与I、II组比较 ,III组术后 12、2 4h的PA -aO2 值下降幅度显著 (P <0 0 5 ) ,CaO2 、SaO2 和PaO2 的下降较少 ,但差异有显著性 (P <0 0 5 )。III组呼吸机支持时间最短 ,气管插管拔除后自主呼吸频率最慢但平顺 ,肺部罗音的发生率最低 ,改变有统计学意义。结论　体外循环过程造成肺损害 ,表现为一些亚临床性肺功能损伤。乌司他丁对肺功能有保护作用 ,其中 2万U kg组肺保护作用优于 1万U kg组。更多还原

【Abstract】 Objective: To study the effects of ulinastatin （UTI） on lung function after cardiopulmonary bypass. Methods: 60 patients, ASA score II～III, scheduled for elective cardiac valvular replacement, were randomly allocated into three groups. Study group （group I, n=20）, UTI 10?000 U/kg group （group II, n=20）, and UTI 20?000 U/kg group （group III, n=20）. OI, V_D/V_T, P（A-a）O₂, CaO₂ , SaO₂ and PaO₂ were studied respectively. Ventilation time, simultaneous breath frequency within 24 hours after extubation and respiratory changes were also observed. Results: Compared with pre-CPB, in group I, postoperative OI, V_D/V_T, P （A-a） O₂ increased and CaO₂, SaO₂, PaO₂ decreased, respectively （P<0.05）. Compared with group I and group II, in group III, postoperative OI was much lower （P<0.05）, P （A-a） O₂ at 12, and 24?h post-operation dropped more obviously （P<0.05）, but CaO₂, SaO₂ and PaO₂ had no significant changes. Group III had a shortest ventilation time, lowest simultaneous breath frequency and least rales （P<0.05）. Conclusion: CPB led to lung injury with sub-clinical manifestations. Ulinastatin could protect lung function and the effect of UTI 20?000 U/kg was better than that of UTI 10?000 U/kg.更多还原