The Effect Of Ulinastatin In Combination With The Modified Ultrafiltration On Pulmonary Function In Infant Open Heart Surgery

Objective Through the comparative study to use ulinastatin in combination with the modified ultrafiltration and use alone and not to use ulinastatin and modified ultrafiltration in open heart surgery of the infant with congenital heart disease who come from the cardiac surgeons diagnosis and treatment center of the affiliated hospital of jining medical college and whose weight are under the15kilograms from February,2011to June2011(according to the same sex, age, weight, illness with similar, the infants are made up with pairs, and then each individual is divided respectively into four groups on the basis of the random distribution and each group include15people), this subject aims to explore:(1) whether combined ulinastatin with modified ultrafiltration could produces an better protective action than used them alone on pulmonary function in infant open heart surgery or not.(2)To explore the pulmonary protection mechanism of the ulinastatin and modified ultrafiltration which are used in infant open heart surgery. Methods60cases with congenital heart disease were divided into control group (C), ulinastatin group (U),modified ultrafiltration group (M) and ulinastatin with modified ultrafihration group(D). four groups all use the right micro sicision under the armpit, tracheal intubation composite anesthesia, narcotic induction and drug maintenance are basically the same, do aorta and the inferior vena cava intubation, establish extracorporeal circulation conventionally, perfuse cold liquid crystal cardiac arrest in aortic root, first dose of20ml/kg, then add to the half quantity every half hour. The group C is used as blank control (do not use ulinastatin and modified ultrafiltration), M、D group begin to use modified ultrafiltration after downtime, the flow is15～20ml/kg/min, and the ultrafiltration time is10～15min. At the same time in group U and D the ulinastatin is pumped into according to10000U/Kg after narcotic induction befor the CPB. The pneumodynamic parameters and inflammatory mediators were measured at specific time points. The airway peak pressure (Ppeak),pause breathing pressure (Ppause), tidal volume (TV), breathing rate (F), inhaled oxygen concentration (FiO2) are recorded in5min before the start of CPB, the20min after the end of CPB (T2), after two h, postoperative6h, postoperative12h. At the same time collect two tubes of artery blood with2.5ml. one is done blood gas analysis, recording the alveolar-blood oxygen partial pressure difference (A-aDO2), arterial oxygen partial pressure (PaO2), carbon dioxide points pressure (PCO2); the other is anticoagulated by heparin, and cryopreserved after centrifugation, measuring the concentrations of IL-6and IL-8through radiation immune method, according to the operation instructions kit. According to the records of the lung function index and blood gas analysis results, calculate:lung static compliance=TV/(Ppause-PEEP); Raw airway resistance=(Ppeak-Ppause)×0.6×insp%/(TV×F); Oxygen and index OI=PaO2/FiO2.Results The difference of the quantity, aortic blocking time and extracorporeal circulation time of each group was statistically significant (P>0.05).The static pulmonary compliance(Cstat), peak air way pressure(Raw), alveolar-arterial oxygen difference(A-aDP2),oxygen index(OI) and the level of IL-6、IL-8were dramatically different after CPB in the four groups. At T4、T5time points, the D group’s Cstat and OI were higher while the Raw and A-aD02were lower than the other three groups (P<0.05). In the U and D groups, the level of IL-6and IL-8were lower compared to those of M and C groups at T2、T3、T4、T5times(P<0.05), while they were no dramatically significant between the C and M group at each point time (P>0.05).Conclusions Combined ulinastatin with modified ultrafiltration produces an better protective action than used alone on pulmonary function in infant open heart surgery. Ulinastatin plays a significant role in reducing the inflammatory factor, while modified ultrafiltration do not. Modified ultrafiltration plays a significant role in concentrating blood, reducing pulmonary edema and the airway pressure, improving lung compliance, and then improve the pulmonary ventilation and air exchange function.