The Effect Of Ulinastatin During Open Heart Surgery With Beating Heart On Systemic Inflammatory Reaction

Objective To investigate the effect of ulinastatin(UTI) during beating heart surgery on systemic inflammatory reaction. Method Forty patients undergoing open heart surgery with beating heart under cardiopulmonary bypass(CPB) were randomly divided into two groups: control group(C) and ulinastatin group(U). Group U(n=20) received UTI 100,000 units(30,000 units was given intravenously before CPB, 40,000 units was added into the primary solution during CPB and 30,000 units was given intravenously after discontinuation of CPB) and group C(n=20) received same volume of normal saline instead of ulinastatin. Blood samples were taken before skin incision(T1), 15 min after start of CPB(T2), end of CPB(T3), 15 min after the end of CPB(T 4), 30 min after the end of CPB( T5), the end of the surgery(T6), 2 h after the surgery(T7), 24 h after the surgery(T8) for determination of PMN count and plasma levels of TNF-α, IL-1, IL-6. Results The level of PMN was significantly higher from T2 to T8 in two groups. PMN level was lower in group U at T3~T6 than that in group C(P<0.05). The plasma concentrations of TNF-α were significantly higher from T2 to T6 in two groups. TNF-α concentration was lower in group U at T4,T5 than that in group C(P<0.05). The concentration of IL-1 was significantly higher from T2 to T5 in control group(P<0.05), whereas there was no significant change in ulinastatin group(P>0.05). IL-1 concentration was lower in group U at T2~T6 and T8 than that in group C(P<0.05). The plasma concentration of IL-6 was significantly higher from T4 to T8 in group C(P<0.05). IL-6 concentration was significantly lower in group U at T3~T7 than that in group C(P<0.05). Conclusion Ulinastatin can reduce inflammatory response induced by beating heart surgery with cardiopulmonary bypass and effectively protect the important organs.