Effects Of Different Dose Of Ulinastatin On Lung Injury And Pulmonary Function After Cardiopulmonary Bypass

Objective: To evaluate the effect of ulinastatin on the changes of inflammatory cytokines and inflammatory response resulting from cardiopulmonary bypass (CPB) in cardiac valve replacement surgery and to investigate the protective effect of ulinastatin on lungs. Methods: 45 patients, NYHA score II~III, scheduled for elective cardiac valvular replacement were randomly divided into three groups: control group (n=15), group U1 (n=15) and group U2 (n=15). Blood samples were taken from central vein for determination of plasma TNF -α, IL- 6, IL - 10 and sICAM-1 concentrations before operation (T1) , 1, 4, 24 h after CPB (T2, T3, T4) respectively. All of these were estimated by enzyme - linked immunosorbent assay (ELISA). At the same time points, inhaled oxygen concentration and arterial blood gas analysis were recorded for calculation of oxygen index (OI), respiratory index (RI) and the Cs, Cd were studied respectively. Results: Among the three groups at T1, there were no significant difference in the plasma concentrations of inflammatory cytokines and the respiratory functional parameters (P>0. 05). Compared with the control group at T3~4: the plasma level of TNF-α, IL-6 and sICAM-1 of both ulinastatin groups were significantly lower; the OI, Cs and Cd of the two ulinastatin groups were significantly higher; The RI of the two ulinastatin groups were lower. The plasma level of IL- 10 of both ulinastatin groups at T2~3 were significantly higher (P<0.05). Compared with U1 group at T3~4: the plasma level of TNF-α, IL-6 and sICAM-1 of U2 group were significantly decreased; the plasma level of IL-10 of U2 group were increased; the OI of the U2 group were higher and the RI of the U2 group were lower (P<0.05) . The Cs and Cd were significantly increased in the group U2 at T2~3 (P<0.05). Conclusion: Inflammatory responses occur during CPB in all patients. Ulinastatin can significantly inhibit the inflammatory cytokine release and reduce the inflammatory responseo. To lessen the lung inflammatory response to cardiopulmonary bypass and protect pulmonary function, ulinastatin is dose-effect relation.