Application Of Ulinastatin During Cardiopulmonary Bypass In Infants

Objective Systemic inflammatory response causes dysfunction of heart and lung, results in high mortality during and after cardiopulmonary bypass(CPB) in infant.Ulinastatin can inhibit the release of many enzymes, suppress their activities and clean free radicals. Ulinastatin may play an important role in protection of human organ function during and after surgery. Application of ulinastatin has been approven in cardiopulmonary bypass in adult. But there is few studies on application of ulinastatin in infant at present. In this study, we are intented to investigate the effect of ulinastatin on inflammatory response and the protective effect on the ischemic/reperfusion myocytes during and after CPB in infant.Methods Tirty-eight infants with VSD , aged 6-24months, weight 4-14kg, were randomly divided into two groups: group U(n=18)receiving ulinastatin 6000UI/kg intravenously before aortic cannula and 6000UI/kg in the priming solution; GroupC(n=20)receiving no ulinastatin. Blood samples were taken for blood gas analysis and the measurement of tumor necrosis factor-a(TNF-a), interleukin-6(IL-6), interleukin-8 (IL-8) before operation and 1,4,24 hours after operation, for the measurement of CK, CK-MB, CTnl before CPB , at 0, 30min after aortic declamping and 4,24 hours after the termination of CPB. The aortic clamping time and CPB time were recorded. The amount of inotropic drugs and the heart spontaneous return were observed. Lung and myocytes were obtained after operation for study ultrastructural alterations.Results 1. After CPB, the levels of TNF-a,IL-6 and IL-8 increased compared with preoperation(P<0.05) in both groups.The levels of IL~6 in the group U decreased significantly compared with group C(P<0. 01);IL-8 in group U decreased compared with group C (P<0. 05) ; TNF- a in group U decreased compared with group C(P<0. 05) at 4 and 24 hours after operation. 2. The time of tracheal intubation in group U was obsioursly shorter than that in group C(P<0.05); Pa02 in group U increased compared with group C(P<0. 05) ;PaC02 and A-aD02 were lower than those in group C(P<0. 05) at 4 and 24 hours after operation;Ultrastructural alterations indicated that injury of lung in group U were less severe than in group C. 3. After CPB, the levels of CK, CK-MB and CTnl increasedcompared with preoperation(P<0.05) in both groups;CK and CK-MB in group U decreased compared with group C(P<0. 05) ; CTnl in group U decreased compared with group C(P<0. 0l"0. 05) at 30min after aortic declamping and 4, 24hours after the termination of CPB. 4. The amount of inotropic drugs used postoperatively in group U is less than that in group C(P<0.05); the spontaneous return rate in group U increased obsioursly compared with group C(P<0.01); Ultrastructural alterations indicated that injury of myocytes in group U were less severe than in group C.Conclusion Ulinastatin(12000UI/kg) can inhibit the inflammatory cytokine(TNF-a , IL-6, IL-8) release, is effective in reducing imflammatory response induced by CPB and has a lung protective effect; It can protect the heart from ischemia-reperfusion injury in infants.