【摘要】 目的观察乌司他丁联合前列地尔对体外循环冠状动脉旁路移植术患者术后肺损伤的影响。方法选取2013—2016年在佛山市第一人民医院行体外循环冠状动脉旁路移植术的患者164例,随机分为对照组(n=41)、前列地尔组(n=41)、乌司他丁组(n=41)和联合用药组(n=41)。对照组患者不做任何处理,前列地尔组患者麻醉诱导后经静脉微泵恒速泵入前列地尔,乌司他丁组患者麻醉诱导后经静脉微泵恒速泵入乌司他丁,联合用药组患者同时使用前列地尔和乌司他丁。比较4组患者硫酸鱼精蛋白用药前(T1)和硫酸鱼精蛋白用药后1 h(T2)血清炎性细胞因子水平[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)、中性粒细胞黏附分子CD11b/CD18]和肺功能指标[动脉血氧分压(Pa O2)、肺泡-动脉氧分压差(A-a DO2)、呼吸指数(RI)和氧合指数(OI)]。结果 T1时4组患者血清IL-6、IL-8、IL-10、TNF-α及CD11b/CD18水平比较,差异无统计学意义(P>0.05);T2时前列地尔组、乌司他丁组及联合用药组患者血清IL-6、IL-8、IL-10、TNF-α及CD11b/CD18水平低于对照组,联合用药组患者血清IL-6、IL-8、IL-10、TNF-α及CD11b/CD18水平低于前列地尔组和乌司他丁组(P<0.05)。T1时4组患者Pa O2、A-a DO2、RI、OI比较,差异无统计学意义(P>0.05);T2时前列地尔组、乌司他丁组、联合用药组患者Pa O2、OI高于对照组,而A-a DO2和RI低于对照组(P<0.05)。结论乌司他丁联合前列地尔可有效减轻体外循环冠状动脉旁路移植术患者的炎性反应,改善患者肺功能。更多还原

【Abstract】 Objective To observe the effects of ulinastatin combined with alprostadil on lung injury in patients undergoing coronary artery bypass surgery under cardiopulmonary bypass. Methods A total of 164 patients undergoing coronary artery bypass surgery under cardiopulmonary bypass were selected as research objects in First People’ s Hospital of Foshan City form January 2013 to December 2016. All of patients were randomly assigned to control group( A group,n = 41),alprostadil group( B group,n = 41),ulinastatin group( C group,n = 41),alprostadil combined with ulinastatin group( D group,n =41). A group without any treatment, B group was given alprostadil, C group was given ulinastatin, D group was given ulinastatin and alprostadil. The serum levels of inflammatory cytokines( IL-6,IL-8,IL-10,TNF-α,CD11b/CD18) and lung function index( Pa O2,A-a DO2,RI,OI) in the four group before treatment of protamine sulfate( T1) and after treatment 1 h of protamine sulfate( T2) were compared. Results No statistically significant difference of serum level of IL-6,IL-8,IL-10,TNF-α,CD11b/CD18 in four groups in T1 time point( P > 0. 05); T2 time point,serum level of IL-6,IL-8,IL-10,TNF-α,CD11b/CD18 of B,C,D groups were statistically significantly lower than those of A group,serum level of IL-6,IL-8,IL-10,TNF-α,CD11b/CD18 of D groups were statistically significantly lower than those of B,C groups( P < 0. 05). No statistically significant difference of Pa O2,A-a DO2,RI,OI in four groups in T1 time point( P > 0. 05);T2 time point,Pa O2、OI of B,C,D groups were statistically significantly higher than those of A group,A-a DO2和 RI of B,C,D groups were statistically significantly lower than those of A group( P < 0. 05). Conclusion Ulinastatin combined with alprostadil can effectively reduce the inflammatory reaction in patients undergoing coronary artery bypass surgery under cardiopulmonary bypass,and protect lung function.更多还原