Effects of ulinastatin treatment on the cardiopulmonary bypass-induced hemodynamic instability and pulmonary dysfunction
Effects of ulinastatin treatment on the cardiopulmonary bypass-induced hemodynamic instability and pulmonary dysfunction
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DOI：
10.1097/01.ccm.0000215110.55899.ae
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发表时间：
2006-05-01
影响因子：
8.8
通讯作者：
Kitamura, A
中科院分区：
文献类型：
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作者：
Nakanishi, K;Takeda, S;Kitamura, A
目的：探讨体外循环后尿胰蛋白酶抑制剂所致的促炎细胞因子释放减少与心肌和肺损伤减少之间的关系。设计：前瞻性、随机、双盲研究。研究对象：30例体外循环下冠状动脉搭桥术患者。干预：15例患者在行主动脉体外循环前立即静脉注射尿胰酶抑制剂5000 U/kg或生理盐水15例。测量及主要结果。分别于插管后即刻(T1)、主动脉插管前即刻(T2)、体外循环结束后(T3)、手术结束时(T4)、术后第1天(T5)、第3天(T6)、第5天(T7)测定中性粒细胞弹性蛋白酶、肿瘤坏死因子-α、白介素6和白介素8。在所有采样时间获得同步的红细胞压积数值。测定肌酸激酶与肌肉和脑组织亚基的同工酶、肌钙蛋白-T和肌球蛋白轻链I。围手术期获取各种血流动力学和肺功能数据。对中性粒细胞弹性蛋白酶和细胞因子水平进行血液稀释校正。尿胰酶抑制剂组T3、T4时IL-6、IL-8水平均低于对照组。对照组每搏输出量指数在T3时显著降低，T3时组间比较差异有统计学意义(P
Objective: To examine the association between decreased release of proinflammatory cytokines in response to urinary trypsin inhibitor pretreatment and decreased myocardial and lung injury after cardiopulmonary bypass.Design: A prospective, randomized, double-blind study.Setting. University hospital.Subjects: Thirty patients on cardiopulmonary bypass undergoing coronary artery bypass grafting.Interventions: Patients received 5000 units/kg intravenous urinary trypsin inhibitor (n = 15) or 0.9% saline (control, n = 15) immediately before aortic carmulation for cardiopulmonary bypass.Measurement and Main Results. Neutrophil elastase, tumor necrosis factor-alpha, interleukin-6, and interleukin-8 were measured after intubation (T1), immediately before aortic cannulation (T2), after separation from cardiopulmonary bypass (T3), at the end of surgery (T4), and on postoperative days 1 (T5), 3 (T6), and 5 (T7). Simultaneous hematocrit values were obtained at all sample times. lsoenzyme of creatine kinase with muscle and brain subunits, troponin-T, and myosin light chain I were also measured. Various hemodynamic and pulmonary data were obtained perioperatively. Levels of neutrophil elastase and cytokines were corrected for hemodilution. Interleukin-6 and interleukin-8 levels were lower at T3 and T4 in the urinary trypsin inhibitor group than in the control group. Stroke volume index was significantly decreased in the control group at T3, and statistical difference was found between groups at T3 (p