CAJ | 학술논문

目的：评价乌司他丁对体外循环（CPB）下心脏瓣膜置换术患者心功能及心肌细胞凋亡的影响。方法选择择期全身麻醉 CPB 下行心脏瓣膜置换术患者80例，NYHA 心功能和 ASA 分级为Ⅱ—Ⅲ级。采用随机数字表法将80例患者分为乌司他丁组（U 组，n＝40）和生理盐水对照组（C 组，n＝40）。U 组于主动脉开放前5 min 自主动脉根部灌注乌司他丁4000～5000 U·kg－1·min－1（剂量10000 U·kg－1）；C 组给予等容量生理盐水。观察2组患者的心功能，记录多巴胺及肾上腺素用量，另于升主动脉开放后45 min 时取右心耳心肌组织，并检测 Bax、Bcl-2蛋白的表达和心肌细胞凋亡情况，计算 Bcl-2与 Bax 比值（Bcl-2／Bax）及凋亡指数（AI）。结果与 C 组比较，U 组主动脉开放3～5 min 的心脏自动复跳率升高，心律失常评分、多巴胺及肾上腺素用量减少，Bax 蛋白表达下调， Bcl-2蛋白表达上调，Bcl-2／Bax 升高，AI 降低（均 P ＜0．05）。结论乌司他丁通过促进 Bcl-2／Bax 通路减轻 CPB下心脏瓣膜置换术患者心肌细胞的凋亡，同时患者心功能也得到改善。
목적：평개오사타정대체외순배（CPB）하심장판막치환술환자심공능급심기세포조망적영향。방법선택택기전신마취 CPB 하행심장판막치환술환자80례，NYHA 심공능화 ASA 분급위Ⅱ—Ⅲ급。채용수궤수자표법장80례환자분위오사타정조（U 조，n＝40）화생리염수대조조（C 조，n＝40）。U 조우주동맥개방전5 min 자주동맥근부관주오사타정4000～5000 U·kg－1·min－1（제량10000 U·kg－1）；C 조급여등용량생리염수。관찰2조환자적심공능，기록다파알급신상선소용량，령우승주동맥개방후45 min 시취우심이심기조직，병검측 Bax、Bcl-2단백적표체화심기세포조망정황，계산 Bcl-2여 Bax 비치（Bcl-2／Bax）급조망지수（AI）。결과여 C 조비교，U 조주동맥개방3～5 min 적심장자동복도솔승고，심률실상평분、다파알급신상선소용량감소，Bax 단백표체하조， Bcl-2단백표체상조，Bcl-2／Bax 승고，AI 강저（균 P ＜0．05）。결론오사타정통과촉진 Bcl-2／Bax 통로감경 CPB하심장판막치환술환자심기세포적조망，동시환자심공능야득도개선。
Objective To evaluate the effects of ulinastatin on cardiac function and myocardial apoptosis in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB). Methods Eighty NYHA and ASA Ⅱ-Ⅲ patients scheduled for cardiac valve replacement with CPB were randomly divided into two groups,with 40 patients in each group.The group U was given aortic root perfusion of 10 000 U·kg-1 ulinastatin (4 000-5 000 U·kg-1 ·minute-1 )5 mi-nutes before aortic unclamping.The group C was given the same volume of normal saline.Cardiac function was observed in both groups,rocord the arnount of dopamine and adrenaline.In addition, myocardial tissues were obtained from right atrial appendage 45 minutes after aortic unclamping to determine the protein expression of Bax and Bcl-2 and the myocardial apoptosis.The Bcl-2/Bax ratio and apoptotic index(AI)were calculated.Results Compared with group C,ulinastatin per-fusion increased auto-resuscitation rate,decreased arrhythmia score and usage of dopamine and adrenaline,down-regulated Bax expression,up-regulated Bcl-2 expression,elevated Bcl-2/Bax rati-o,and reduced AI(P <0.05).Conclusion Ulinastatin can attenuate myocardial apoptosis and im-prove cardiac function through regulating Bcl-2 and Bax expression in patients undergoing cardiac valve replacement with CPB.