1 乌司他丁对体外循环心脏手术患者 TXA 2 和 PGI 2的影响作者:林学正周春莲林仙菊【摘要】目的观察乌司他丁(UTI) 对体外循环(CPB) 心脏手术患者血栓素(TXA 2) 和前列环素(PGI 2)的影响。方法将 60例 CPB 择期心脏手术患者随机分为实验组和对照组, 分别采用 UTI 万 U/kg 稀释于 10m1 生理盐水中和等量生理盐水中,一次性加入 CPB 预充液中,分别于麻醉诱导后(T1) 、主动脉开放 30min(T2) 、术毕(T3) 及术后 6h(T4)4 个时点,抽取桡动脉血用放射免疫法测定 TXB2/6-keto-PGF 1α浓度。结果 CPB 后两组患者 T2 、 T3 、 T4 血浆 TXB2 、 TKG 6-keto-PGF 1α浓度均较 T 1浓度增加() , 但实验组增加幅度低于对照组() , 且术后 6h TXB2 、 6-keto-PGF 1α浓度己降到或低于术前水平() 。结论血浆 TXA 2和 PGI 2比值升高, 可能是 CPB 后肺损伤的机制之一。乌司他丁对 CPB 后肺损伤的保,护作用可能与改善花生四烯酸代谢紊乱,抑制 TXA 2 /PGI 2比值升高有关。 2 【关键词】乌司他丁体外循环肺损伤血栓素前列环素【 Abstract 】 Objective To study the effect of ulinastatin on thromboxane A2(TXA2) and prostaglandin I2(PGI2) in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods Sixty patients undergoing cardiac surgery with CPB were randomly divided into two groups. In experimental group , × 104 U/Kg of Ulinastatin was added to the CPB priming solution, replaced by the same volume normal saline in control group. Radical artery blood sample were taken for determination of thromboxane B2(TXB2) and 6-kete-prostaglandin F1 α(6-keto-PGF1 α)by radioimmunity after induction of anesthesia(T1) , 30min after release of aortic cross-clamp(T2), end of operation(T3) and 6h after operation(T4). Results: Compared with T1, plasma levels of TXB2 、 6-keto-PGF1 α and TXB2/6-keto-PGF1 α in both groups were increased significantly at T2, T3 and T4 (). and plasma levels of TXB2 、 6-keto-PGF1 α and TXB2/6-keto-PGF1 α in control group was higher than that in experimental group(). Conclusion Changes of plasma levels of TXA2/PGI2 may be in charge of acute lung injury after CPB. Ulinastation could inhibit the increase of TXA2/PGI2 and may be benefit to respiration 3 function in patients undergoing cardiac surgery with cardiopulmonary bypass. 【 Key Words 】 Ulinastatin Cardiopulmary bypass Lung injury Thromboxane A2 Prostaglandin I2 体外循环(CPB) 术后肺损伤一直是心血管外科研究的难点之一。全身炎性反应(SIRS) 是 CPB 后诱发急性肺损伤发生的主要机制[1], 而血栓素(TXA 2) 和前列环素(PGI2)
