CAJ | 학술논문

目的观察体外循环中应用乌司他丁对双瓣置换患者围术期溶酶体膜稳定性及凝血功能的影响。方法在体外循环下行二尖瓣联合主动脉瓣置换患者20例，随机分为乌司他丁组及对照组，乌司他丁组患者按20000 U/kg总量给予乌司他丁，其中半量预充，半量于主动脉开放前加入到体外循环管路中，对照组患者给予等量生理盐水。分别于术前30 min，体外循环60 min、120 min及体外循环结束后30 min采集血样，ELISA方法检测血浆中组织蛋白酶D（ CTSD）及N-乙酰-β-D-氨基葡萄糖苷酶（ NAG）含量；采用血栓弹力图比较手术前后凝血功能。同时，记录术后ICU滞留时间、引流量、24 h尿量及呋塞米用量，以及术后呼吸机辅助时间、死亡等情况。结果两组患者均顺利出院，无死亡，无严重并发症；术后ICU时间、机械通气时间、术后第1个24小时尿量及呋塞米用量组间无显著差异（ P＞0.05）；与对照组比较，凝血功能各项指标在手术结束后未见明显差异（ P＞0.05）；体外循环过程中各时间点NAG及CTSD含量组间无显著差异（ P＞0.05）。结论体外循环中应用乌司他丁20000 U/kg对双瓣置换患者围术期溶酶体稳定性及凝血功能的保护作用与对照组没有明显差异。
목적관찰체외순배중응용오사타정대쌍판치환환자위술기용매체막은정성급응혈공능적영향。방법재체외순배하행이첨판연합주동맥판치환환자20례，수궤분위오사타정조급대조조，오사타정조환자안20000 U/kg총량급여오사타정，기중반량예충，반량우주동맥개방전가입도체외순배관로중，대조조환자급여등량생리염수。분별우술전30 min，체외순배60 min、120 min급체외순배결속후30 min채집혈양，ELISA방법검측혈장중조직단백매D（ CTSD）급N-을선-β-D-안기포도당감매（ NAG）함량；채용혈전탄력도비교수술전후응혈공능。동시，기록술후ICU체류시간、인류량、24 h뇨량급부새미용량，이급술후호흡궤보조시간、사망등정황。결과량조환자균순리출원，무사망，무엄중병발증；술후ICU시간、궤계통기시간、술후제1개24소시뇨량급부새미용량조간무현저차이（ P＞0.05）；여대조조비교，응혈공능각항지표재수술결속후미견명현차이（ P＞0.05）；체외순배과정중각시간점NAG급CTSD함량조간무현저차이（ P＞0.05）。결론체외순배중응용오사타정20000 U/kg대쌍판치환환자위술기용매체은정성급응혈공능적보호작용여대조조몰유명현차이。
Objective To investigate the effects of ulinastatin on the stability of lysosomal membrane and blood coagulation functions in patients undergoing mitral and aortic valves replacement .Methods Twenty consecutive patients scheduled for mitral and aortic valve replacement surgery under cardiopulmonary bypass (CPB) were randomized into two groups:ulinastatin group , who received 20 000 U/kg ulinastatin during CPB with half added into the prime solution and half added to the circuit upon aortic clamping removal;control group , who received same volume of saline .Blood sample were collected at 30 min before the operation ,60 min and 120 min after the initiation of CPB ,and 30 min after the termination of CPB .Serum concentration of cathepsin D ( CTSD) and n-acetyl-β-glucosaminidase ( NAG) were measured with ELISA .Perioperative blood coagulation functions were examined with thrombelastogram .Post operative deaths and complications , ICU stay , mechanical ventilation time , drainage volume ,urine volume and furosemide usage during the first postoperative 24 h were also recorded .Results There was no death, no severe complications in both groups .The post operative parameters such as ICU stay , mechanical ventilation time ,urine volumes and furosemide usage during the first postoperative 24 h were similar between the two groups.Post operative blood coagulation functions were comparable between the two groups .Serial serum concentrations of CTSD and NAG were not significantly different between the two groups .Conclusions Compared with control,20 000 U/kg ulinastatin used during CPB has no significant effects on the lysosomal membrane stability and blood coagulation functions in patients undergoing mitral and aortic valves replacement .