Effects Of Ulinastatin On Infant Pancreatin During Open Heart Surgery With Cardiopulmonary Bypass

Objectives:This study aims to dynamic evaluate the concentration of the Immunoreactive trypsin, amylase, lipase and TNF-α between two groups, analyse the change law of the markers, research the dynamic variation of pancreatic enzymes and TNF-α of the children who undergo the cardiopulmonary bypass(CPB), and to investigate the effect of ulinastatin to the CPB.We also study if TNF-α have an affair with the changes of pancreatic enzymes in cardiac surgery with CPB and the protective effect of ulinastatin on the pancreas after childrens cardiac surgery.Method:Forty children with perimembranous ventricular septal defect submitted to cardiac surgery with CPB were enrolled and randomly divided into two groups: Experimental group(group U) and Control group(group C). group U was given with ulinastatin15000unit/Kg in40ml normal saline, group C was given with the same dose of normal saline without Ulinastatin.Blood samples were taken before CPB(Tl);5min(T2),2h(T3),6h(T4) after the beginning of CPB; on the morning of the first postoperative day(T5) and on the second(T6), third(T7), fifth(T8) and seventh(T9) postoperative day for measurements of pancreatic enzymes(amylase, lipase, immunoreactive trypsin and TNF-α). Then the serum were collected by the centrifugation with3000r,10minutes, and was tag-packed in the cryopreservation at-80.C. Use the ELISA method to detect the concentration of pancreatic enzymes and TNF-αResults:Between the two groups at T1, there was no significant difference in the plasma concentration of amylase, lipase and immunoreactive trypsin(P>0.05). Compared with T1, their plasma level at T3-7were significantly higher(P<0.05), and the highest level was at T5. Compared with the control group at T3-7, the plasma level of these enzymes of the ulinastatin group were significant lower(P<0.05).The plasma concentration of TNF-α of two groups have no significant difference at T1(P>0.05). Compared with T1, the concentration of TNF-α at T3-7of the control group was significantly increased and the top level come up at T5. Compared with the control group at T3-7, the plasma level of TNF-α was significantly decreased.There were no statistically significant (P>0.05) of not only mechanical ventilation time, but also intensive care time and post-operative hospitalization time between the two groups (P>0.05).Conclusion:During the cardiac surgery with cardiopulmonary bypass, the plasma concentration of TNF-α increased significantly. Ulinastatin can reduce its level and restrain the inflammatory response.Pancreatic cellular injury is frequent after infants’ cardiac surgery with cardiopulmonary bypass, and ulinastatin can protect the pancreatic cell, so it can reduce the level of pancreatic enzymes.The increase of TNF-a and inflammatory response have an affair with pancreatic cellular injury during the infants’ cardiac surgery with CPB.The mechanical ventilation time, intensive care time and post-operative hospitalization time between the two groups have no statistically difference (P>0.05).