The Protective Effect Of Ulinastatin On Lung And Kidney For Patients With Valve Replacement

Objective: Lung and kidney injury after valve replacement in cardiac surgery are the most common complications. Therefore, it has a very important significance to search for prevention and treatment of pulmonary and renal injury measures to reduce the incidence of postoperative complications and improve surgical outcomes. This study observe patients with valve replacement dose of UTI on arterial partial pressure of oxygen(PaO₂), arterial saturation of oxygen(SaO₂), arterial oxygenation index (PaO₂/FiO₂), respiratory index (RI) and blood urea nitrogen (BUN) and creatinine (Crea), etc. indicators and explore the protective effect of Ulinastatin on lung and kidney for patients with valve replacement.Methods: Collect 60 cases of patients who needed to receive heart valve replacement surgery, and they are the first, elective valve replacement surgery received and the cardiac function is 2³. They were all excluded by severe pulmonary dysfunction, and severe liver, kidney, coagulation abnormalities. The ones whose left ventricular ejection fraction (LVEF)<0.45, left ventricular end diastolic diameter (LVEDD)>70mm, cardiothoracic ratio>0.7, hemodynamic instability, and emergency surgery were not selected. These 60 patients were randomly divided into two groups:treatment group (U group=30 cases) and control group (C group=30 cases).U group were given 10,000 IU/kg before sternotomy ulinastatin; while control group were given only normal saline.â‘ Extract arterial blood gas at the point of declamping the aortic after induction of anesthesia (T1), 10 minutes (T2), 2h (T3), 6h (T4) and 12h (T5) after releasing of aortic cross-clamping, and record arterial partial pressure of oxygen (PaO₂), oxygen saturation (SaO₂), the oxygenation index (PaO₂/FiO₂), respiratory index (RI) and other indicators;â‘¡Extract arterial blood gas at the point of declamping the aortic after induction of anesthesia (T1), 1D(T6), 3D(T7), 5D(T8) and 7D(T9) postoperative, and record blood urea nitrogen (BUN) and creatinine (Crea). To analysis the protective effect of Ulinastatin on lung and kidney for patients with valve replacement by comparing the results of these indicators for the monitoring.Results:1 Comparison of generalThere was no significant (P> 0.05) difference between treatment group and control group in age, body weight, left ventricular ejection fraction (LVEF), cardiac output (CO), aortic cross-clamping time, cardiopulmonary bypass time and minimum nasopharyngeal temperature (℃) .2 Comparison of the arterial partial pressure of oxygen (PaO₂) and oxygen saturation (SaO₂)â‘´After induction of anesthesia (T1), there was no significant difference on PaO₂ in the control group and treatment group (P>0.05);⑵At the point of T2, T3, T4 and T5, t there was significant difference on PaO₂ in the control group and treatment group(P<0.05).⑶There was no significant difference on SaO₂ in the control group and treatment group (P>0.05) at any point.3 Comparison of respiratory index RIâ‘´After induction of anesthesia (T1), there were no significant differences in respiratory index between the treatment group and control group (P>0.05);⑵Compared to T1, the respiratory index of control group were significantly increased at the points of T3 T4 and T5(P<0.01), while the experimental group on the contray. (P> 0.05);⑶The respiratory index of the control group was significantly higher than that of the experimental group at the points of T3 T4 and T5 .(P <0.05).4 Comparison of oxygenation index (PaO₂/FiO₂)â‘´The oxygenation index (PaO₂/FiO₂) of control group and treatment group were begaining to decrease at the point of T1, and to get the lowest level at the point of T4;⑵The level of PaO₂/FiO₂ of control group at T5 point was still lower than that of preoperative, while the level of PaO₂/FiO₂ of treatment group rose to nearly normal level of preoperative;⑶The level of PaO₂/FiO₂ of the control group at the points of T2, T3, T4 and T5 were significantly lower than the treatment group;â‘·The level of PaO₂/FiO₂ of control group at the points of T2, T3, T4 and T5 were significantly lower than the preoperative level(P <0.01), while the level of PaO₂/FiO₂ of treatment group was significantly lower than the preoperative level only at T4 point.(P <0.01) .5 Comparison of glucose and lactic acidâ‘´There were no significant statistically difference in the concentration of glucose between control group and treatment group at all time points.(P> 0.05);⑵Compared to T1, there were significant statistically differences in the concentration of blood lactate at the points of T2, T3, T4 and T5 between control group and treatment group.(P<0.05);⑶The concentration of blood lactate of treatment group were significantly lower than that of the control group at the points of T2, T3, T4 and T5. (P <0.05).6 Comparison of blood urea nitrogen and creatinineâ‘´There were no significant statistically difference in the concentration of BUN and Crea between control group and treatment group at all time points. (P> 0.05);⑵Comparid to preoperative, there were significant difference in BUN and Crea, which were rising, of the control group at the points of T6 and T7(P<0.05), but at the points of T8 and T9 , they fell to the preoperative levels;⑶In experimental group, BUN and Crea were increased at the point of T1, but at other points they were in the normal changes in low range, and there were no significant difference compared with the preoperative (P>0.05);â‘·Compared treatment group and control group at each point after surgery, there was statistically significant only at the points of T5 and T6 between BUN and Crea (P <0.05).Conclusions: The experiment proved that the application of ulinastatin in valve replacement has a significant protective effect on lung and kidney function, it also can lower blood lactate concentration, improved lactate metabolism, control of the disease on the clinical significance of positive progress. There was no effect on glucose of the application of ulinastatin in valve replacement.