Clinical Analysis Of Contrasting Between Ambroxol And Aprotinin On Lung Protection During Cardiopulmonary Bypass

Although the technical of CPB(cardiopulmonary bypass) earns great progress,the injury of lungs is still one of the main complications after CPB.The rates of lungs disfunction after CPB can reach 15%~30%,severitis even lead to acute respiratory distress syndrome or death.Now the mechanisms of the injury of the lungs after CPB isn't very clear. According to most researchers,the damage mechanisms due to the systemic inflammatorome induced by the blood exposed to artificial surface,ischemical reperfusion injury of the lungs and hypermetabolism and high consume of oxygen state when the lungs be relative "high temperature"during the CPB. People used many methods or medicines to reduce lung injury in clinical.The serum proteinase inhibitor aprotinin that had been used widely in clinical can reduce lung injury.But it has been confined in clinic because of causing damage of renal function and end target organ. Although some reports have proved that ulinastatin can protect the lung during CPB,but it has not been widely used in clinical because its newly rising , high cost and unknown side effects.Some drugs have been proved high protection to lung by routine used,but there are rare reports about utilization in CPB.If be proved that they also reduce lung injury during CPB,we can get better protection of lung with less cost.We take the commonly used apophlegmatisant ambroxol,investigate the effect of lung protection during CPB,and compare that with aprotinin.If it be proved also do good protection to lung in CPB,and catch up or even surpass that of aprotinin,we may get better lung protection with less cost,and offer some theories or experiences to clinic.Objective:1. Validate the lung protection of ambroxol during CPB.2.Compare the effect of lung protection with aprotinin during CPB.3.Investigate the feasibility of using ambroxol to reduce lung injury during CPB in clinic. Method:Take the serum specimens of 36 patients that block up time more than 40 minutes in CPB in JiangXi People hospital between May 2007 and Jan 2008 .Divided the patients into aprotinin group(A1). ambroxol group(A2) and control group(A3) at random.Every group contain 12 patients.The aprotinin group add aprotinin in priming solution as ambroxol group add only ambroxol,and the control group only add tales doses normal saline.There are not obvious differences among the three groups in clinic.All the abnormities be corrected under CPB. Same as A1 group ,we take 2ml arterial blood at preoperation time, 0h,6h,12h and 24h after CPB,and get the values of interleukin-8 (IL-8) and malonaldehyde(MDA)of different times.Then do arterial blood gas analysis,calculate respiratory index(RI)and oxygenation index(QI) at different times.Do statistical analysis,and compare differences and relationships among the three groups.Result:All the cytokines raise up after operation,the MDA and IL-8 of A1,A2 are lower than of A3 at 0h,6h,12h and 24h after CPB,P<0.05,and MDA and IL-8 of A1 is lower than of A2 at 12h and 24h after CPB,P<0.05.The QI and RI of A1,A2 are better than of A3 at 0h,6h, 12h and 24h after CPB,there is no obvious difference between group A1 and A2.The airway pressure of A1 and A2 are lower than of A3 at 0h,6h and 12h after CPB,P<0.05.Conclusion:1.The experiment prove that ambroxol can reduce lung injury during CPB.2.The effect of lung protection of ambroxol is the same as that of aprotinin in earlier time after the operation,but is weaker in the later time .3.There is determinate feasibility and significance in clinic to use ambroxol to do lung protection during CPB.