【摘要】 目的探讨乌司他丁对非体外循环冠状动脉搭桥术(OPCABG)患者围术期内皮糖萼的影响,探讨乌司他丁的肺保护机制。方法选择择期行OPCABG患者40例,分为对照组(C组,20例)和乌司他丁组(U组,20例)。U组在麻醉诱导后30min内恒速静脉输注乌司他丁6 000 U/kg,然后持续每小时静脉输注1 000U/kg至手术结束;C组采用同样的方法输注等量生理盐水。检测切皮前(T0),全部冠状动脉近端吻合完成后10min(T1),术毕(T2),术后6h(T3)时患者动脉血中多配体蛋白聚糖-1(Syndecan-1)、细胞间黏附分子-1(ICAM-1)水平情况;检测以上各时间点的动脉血气并计算氧合指数(OI)、肺泡动脉血氧分压差(PA-aO2)。结果T0时,两组血浆Syndecan-1及ICAM-1水平,以及OI和PA-aO2比较差异无统计学意义(P>0.05)。血浆Syndecan-1及ICAM-1水平在T1、T2时均升高,U组均低于C组,差异有统计学意义(P<0.05);T3时血浆Syndecan-1水平恢复到基线水平。与T0相比,T1、T2和T3时两组患者OI均降低,PA-aO2均升高,但U组较C组明显改善,差异有统计学意义(P<0.05)。结论乌司他丁可改善OPCABG患者术后肺换气功能,其机制可能与减轻血管内皮糖萼降解,减少内皮下ICAM-1活化有关。更多还原

【Abstract】 Objective To explore the effect of Ulinastatin on perioperative glycocalyx and lung function in patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods Fourty patients,undergoing OPCABG,were assigned into control group(C group,20 cases)and Ulinastatin group(U group,20 cases).In U group,Ulinastatin 6 000 U/kg was injected within 30 min after induction of anesthesia,and then ulinastatin 1 000 U·kg-1·h-1 was infused continuously by intravenous until the end of surgery;in C group,equal amount of normal saline was infused by the same method of U group.The radical artery blood was collected at four time point:before operation(T0),at 10 min after the proximal coronary artery anastomosis was completed(T1),at the end of operation(T2),6 hafter the operation(T3).The level of Syndecan-1 and ICAM-1 in blood was measured.Moreover,the blood gas analyses were preformed and the oxygen index(OI)and difference of alveolar arterial oxygen partial pressure(PA-aO2)were calculated.Results There were no significant difference between two groups in OI,PA-aO2,Syndecan-1 and ICAM-1 at T0(P>0.05).The level of Syndecan-1,ICAM-1 were significant increase at T1,T2 in two groups;furthermore,compared with group C,it was decreased in group U at each time point(P<0.05).The level of Syndecan-1 restored the baseline at T3.Compared with T0,OI decreased and PA-aO2 increased at T1,T2 and T3 in both groups,and the two indexes in group U were improved compared with group C(P<0.05).Conclusion Ulinastatin could improve the postoperative pulmonary ventilation function in patients undergoing OPCABG,the mechanism might be,at partly,attributed to the reduction of glycocalyx shedding and the inhibition of ICAM-1 activation.更多还原