The Effects Of Ulinastatin On Pulmonary Injury In Patients With Rheumatic Mitral Stenosis Undergoing Mitral Valve Replacement

OBJECTIVE:To investigate effects of Ulinastatin (UTI) on pulmonary injury of patients undergoing cardiopulmonary bypass (CPB).METHODS:Twenty-four patients with rheumatic mitral stenosis undergoing mitral valve replacement were randomly assigned to two groups,UTI group(n=12) and control group(n=12).Patients of UTI group received 20000 units/kg ulinastatin and control group received 0.9% saline during operation.The duration of aortery clamp, CPB,mechanical ventilation and staying in ICU were observed. Plasma tumor necrosis factor-alpha (TNF-alpha), Clara cell secretory protein(CC16) concentrations of were measured by ELISA at four timepoints including beginning of operation (T1), 1 hour (T2),2 hours (T3), and 4 hours (T4) after CPB respectively. At the same time points, the FIO2,PaO2,PaCO2,PEEP,Paw were recorded., and respiratory index (RI) and oxygen index(OI) were calculated.RESULTS:The duration of mechanical ventilation was significantly shorten in the UTI group compared with the control group(9.42±2.36vs13.25±3.01,p<0.05), RI and plasma concentrations of TNF-alpha and CC16 increased at T2-4 compared with that in T1 in both groups (P<0.05 or P<0.01), in UTI group at T2-4 were significantly lower than those in control group(P<0.05 or P<0.01).OI decreased at T2-3 compared with the T1 in both groups (P<0.05 or P<0.01), but UTI group at T2-3 was significantly higher than those in control group(P<0.05 or P<0.01). OI was lower at T4 than that at T1 in control group(P<0.05 or P<0.01). OI was lower at T4 than that at T1,but there was not significantly different (p>0.05).The duration of staying in ICU was shorten in UTI group than that in control group(38.83±10.85 vs47.67±12.49) although the difference was not significantly.CONCLUSION:Plasma concentrations of TNF-alpha and CC16 increased after CPB consistent to RI increasement and OI decreasement.Ulinastatin could decrease the concentrations of TNF-alpha and CC16 after CPB, which might protect alveolar capillary membrane,reduce lung injury and improve pulmon ary function. Therefore, administration of ulinastatin during CPB operation could protect lung function.