Ulinastatin In Heart Valve Replacement Surgery In Clinical Research On Myocardial Protection

Objective:Cardiopulmonary bypass (CPB) heart valve replacement surgery ulinastatin on cytokines and inflammatory mediators and ulinastatin (UTI) on myocardial protection, as well as the amount of myocardial protection-effect relationship.Methods:48 cases of heart valve replacement surgery were randomly divided into four groups:control group is C group (12 cases), not used Ulinastatin during CPB; the experimental group is U group (36 cases), whichUlgroup(12 cases), used during cardiopulmonary bypass Ulinastatin 5 000 units/kg; U2 group (12 cases), used during cardiopulmonary bypass Ulinastatin 10 000 units/kg; U3 group (12 cases), used during cardiopulmonary bypass Ulinastatin 20 000 units/kg, the use of half of the total before anesthesia in 5% glucose injection via peripheral venous infusion, the other half by adding pump priming solution. Then patients were measured before anesthesia,10 minutes after aortic occlusion, aortic opening 30 minutes,1 hour after aortic, aortic opening of 8 hours,24 hours after aortic disclosing, and 48 hours after aortic surgery 7 days after the serum creative kinase-MB (CK-MB) and CardiactroponinI (cTnI) changes. Simultaneous detection of patients before anesthesia, 30 minutes after aortic, aortic After 1 hour,24 hours after aortic disclosing and after 3 days of serum IL-6, IL-8 and TNF-a change, addition, monitoring after the use of cardiovascular active drugs and postoperative low cardiac output syndrome (LOCS) and the incidence of arrhythmia.Results:The experimental group and control group in the preoperative clinical data generally no difference in bypass time, aortic clamping time and cardiac auto-resuscitation rate of cardiovascular activity after the drug was no significant difference in usage. Experimental group and control group after CPB serum cTnI and CK-MB were significantly higher than that preoperatively (P＜0.05), at the highest when the aortic opening of 1h, but the increase in the control group even larger. Among groups, the use of small doses ulinastatin group (U1 group) and no significant difference between the control group (P＞0.05), while U2, U3 group increased at the same point in time the high rate significantly lower than the control group (P＜0.05). By monitoring the IL-6, IL-8 and TNF-a change, showed that all after cardiopulmonary bypass in serum inflammatory mediators and cytokines were significantly higher than that preoperatively (P＜0.05), the control group after the opening of the aortic 1h when the highest point on the emergence of a release peak, while U2, U3 group of inflammatory mediators and cytokines after cardiopulmonary bypass increased more slowly, not at the point in time the release of significant peak, and significantly lower than control group (P＜0.05), the other time point compared with slight variation, but not reach statistical significance. After 3 days of fever patients in the experimental group rates and elevated white blood cell count ratio of less than the control group (P＜0.05).Conclusion:Cardiopulmonary bypass heart valve replacement surgery applications-large ulinastatin reduce myocardial ischemia-reperfusion injury and inhibition of systemic inflammatory response syndrome, myocardial protection with a certain role, and within a certain range dosage in this case.