| 梁 治,戚 翔,徐 雪,韩建民,张馥镇.乌司他丁对非停跳冠脉搭桥术患者的心肺保护作用研究[J].,2020,(10):1975-1978 |
| 乌司他丁对非停跳冠脉搭桥术患者的心肺保护作用研究 |
| A Study on the Cardiopulmonary Protective Effect of Ulinastatin on the Patients Undergoing Non-stop Coronary Artery Bypass Grafting |
| 投稿时间：2020-01-28 修订日期：2020-02-24 |
| DOI：10.13241/j.cnki.pmb.2020.10.039 |
| 中文关键词: 乌司他丁 非停跳冠脉搭桥术 心肺 保护作用 |
| 英文关键词: Ulinastatin Nonstop coronary artery bypass grafting Heart and lung Protection |
| 基金项目:河北省医学科学研究重点项目(20100310) |
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| 中文摘要: |
| 摘要 目的：探讨乌司他丁对非停跳冠脉搭桥术患者的心肺保护作用。方法：选取2017年12月-2019年4月我院收治的非停跳冠脉搭桥术患者76例，根据使用的药物不同分为两组，对照组应用常规方法，研究组应用乌司他丁，在麻醉之后切皮之前为T1，旁路血管开放时时间点为T2，手术结束为T3，手术之后的8 h为T4。比较两组治疗前后的心肺功能指标、动脉血气分析及血浆炎症因子、氧合指数术后恢复。结果：和T1进行对比时，两组T3、T4中的气道阻力（Air way Resistance，Raw）、呼吸指数（Respiratory Index，RI）、肺泡-动脉血氧分压差P(A-a )DO2均有所升高，在T2、T4中（PVR）有所升高，在T2、T3、T4中肺顺应性（Compliance of Lung ，CL）有所降低。和对照组进行对比时，研究组在T3、T4中肺循环阻力（pulmonary vascular resistance, PVR）、RI、P(A-a )DO2有所降低，在T2、T3、T4中通气死腔百分比（VD/VT）有所降低（P＜0.05），在T2中CL有所升高(P＜0.05)；治疗前，两组BNP 、TNF-α、IL-6、IL-8无统计学意义（P＞0.05），治疗后BNP 、肿瘤坏死因子（tumor necrosis factor-α，TNF-α）、白细胞介素-6 (Interleukin-6，IL-6)、白细胞介素-8 (Interleukin-8，IL-8)在T1、T2、T3、T4中低于对照组(P＜0.05)，肌钙蛋白（cardiac troponin，cTnI）在T1中和对照组没有明显差异(P＞0.05)，T2、T3、T4中研究组明显低于对照组(P＜0.05) ，研究组氧合指数高于对照组(P＜0.05)；研究组T1、T2、T3、T4时平均动脉压（mean artery pressure，MBP）均高于对照组(P＜0.05)，T1、T2、T3、T4时心率均低于对照组(P＜0.05)；研究组ICU停留时间、ICU带气管插管时间、ICU机械通气时间、肺部并发症均低于对照组(P＜0.05)。结论：乌司他丁用于非停跳冠脉搭桥术的效果较好，可以保护患者的心肺功能。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the cardiopulmonary protective effect of ulinastatin on patients with non-stop coronary artery bypass grafting. Methods: 76 patients with non-stop coronary artery bypass grafting who were admitted to our hospital from December 2017 to April 2019 were selected and divided into two groups according to different drugs used. The control group used conventional methods and the study group used ulinastatin After the anesthesia, it is T1 before skin incision, the time point when the bypass vessel is opened is T2, the end of the operation is T3, and 8 h after the operation is T4. Cardiopulmonary function indexes, arterial blood gas analysis, plasma inflammatory factors, and oxygenation index were compared between the two groups before and after treatment. Results: Compared with T1, the airway resistance (Raw), Respiratory Index (RI), alveolar-arterial blood oxygen partial pressure difference P (Aa) DO2 in both groups T3 and T4 The increase was elevated in T2 and T4 (PVR), and decreased in T2, T3, and T4 (Compliance of Lung, CL). When compared with the control group, the study group's pulmonary vascular resistance (PVR), RI, and P (Aa) DO2 decreased in T3 and T4, and the percentage of ventilated dead space (VD/VT ) Decreased (P<0.05), CL increased in T2 (P<0.05); before treatment, BNP, TNF-α, IL-6, IL-8 in both groups had no statistical significance(P>0.05), BNP, tumor necrosis factor-α(TNF-α), interleukin-6 (Interleukin-6, IL-6), interleukin-8 (Interleukin-8, IL-8) T1, T2, T3, T4 were lower than the control group (P<0.05), troponin (cardiac troponin, cTnI) was not significantly different from the control group in T1 (P>0.05), T2, T3, T4 study The group was significantly lower than the control group (P<0.05), and the oxygenation index of the study group was higher than that of the control group (P<0.05); the mean arterial pressure (MBP) of the MBP study group was higher at T1, T2, T3, and T4. In the control group (P<0.05), the heart rate at T1, T2, T3, T4 was lower than the control group(P<0.05); the study group ICU residence time, ICU endotracheal intubation time, ICU mechanical ventilation time, lung combined Disease were lower than the control group(P<0.05). Conclusion: Ulinastatin has a good effect on non-stop coronary artery bypass grafting and can protect the heart and lung function of patients. |
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