Study On The Effect Of Multiple Drugs Alone Or In Combination On The Inflammatory Reaction And Lung Protection After Cardiopulmonary Bypass

Objective Study of inflammation medium decreased levels and postoperative pulmonary function improvemen perfusion with mild hypothermic cardiopulmonary bypass in separate application of methylprednisolone, ulinastatin, insulin and the combined application.Methods From January 2015 to December 2016 in the First Affiliated Hospital of Zhengzhou University, we choose 60 patients combined valvular disease and they would have an operation, inclouds aortic valve replacement, mitral valve replacement and tricuspid valvuloplasty. They were randomly divided into 6 groups: control group(group C), methylprednisolone group(group U1), ulinastatin group(U2 group), insulin group(U3 group) methylprednisolone + Ulinastatin group(group U4), methylprednisolone + insulin group(U5 group). Arterial blood and venous blood were collected respectively after induction of anesthesia(T1), after the end of CPB(T2), CPB after the end of 2H(T3), after the end of CPB 6h(T4), after CPB 12h(T5), after CPB 24h(T6), that were used to detect arterial blood gas and by ELISA method detect tumor necrosis factor-?(TNF-?) and interleukin-6(IL-6), interleukin-10(IL-10). Sometimes in each time point recording inhaled oxygen concentration, arterial blood gas and respiratory function index were calculated oxygenation index(OI), and observe alveolar arterial oxygen branch pressure difference changes(P(A-a)O2).Results(1) The change trend of TNF-?of different groups was increasing from T1 to T2, reached a peak in T2 and decreased from T2 to T6 gradually. There was significant difference in each time point(P <0.05). Compared with the control group, experience group have significant difference(P<0.05). Compared with the U2 group and U3 group, U1 group have significant difference(P<0.05). Compared with the U1 group, U4 group have significant difference(P<0.05); There were no obvious difference between U1 and U5;(2) The change trend of IL-6 different groups was increasing from T1 to T5, reached a peak in T5 and decreased from T5 to T6 gradually. There was significant difference in each time point(P <0.05). Compared with the control group, experience group have significant difference(P<0.05). Compared with the U2 group and U3 group, U1 group have significant difference(P<0.05). Compared with the U1 group, U4 group have significant difference(P<0.05); There were no obvious difference between U1 and U5;(3) The change trend of IL-10 of different groups was increasing from T1 to T2, reached a peak in T2 and decreased from T2 to T6 gradually. There was significant difference in each time point(P <0.05). Compared with the control group, experience group have significant difference(P<0.05). Compared with the U2 group and U3 group, U1 group have significant difference(P<0.05). Compared with the U1 group, U4 group have significant difference(P<0.05); There were no obvious difference between U1 and U5;(4)To OI, six groups had significant difference at different time points(P < 0.05). Compared between each treatment groups and control group, there was significant difference(p<0.05), Compared with the U2 group and U3 group, U1 group have significant difference(P<0.05). There is no significant difference between U1 group and U4 group and U5 group.(5) group of six patients at different time points P(A-a)O2 had significant difference(P < 0.05) and between groups comparison of each treatment group and control group comparison of P < 0.05, methylprednisolone group, ulinastatin group and insulin group, P < 0.05. There is no significant difference between methylprednisolone group and methylprednisolone + Ulinastatin group and methylprednisolone + insulin group.Conclusions Inflammatory response occurred in all patients during cardiopulmonary bypass. During cardiopulmonary bypass(CPB), methylprednisolone, ulinastatin, insulin can inhibit Pro inflammatory cytokines, anti-inflammatory cytokine release, reduce lung injury, improve lung function after CPB. But the methylprednisolone is superior in cardiopulmonary bypass lung protection of ulinastatin and insulin. He d have a synergistic effect in suppressing inflammation of autologous aspects of methylprednisolone and ulinastatin and its anti-inflammatory effect is better than that of separate application of methylprednisolone in separate application of ulinastatin his Ding. Three drugs can make the in vitro circulation postoperative lung function improved and more effect of methylprednisolone, combined with ulinastatin he Ding and insulin no significant differences.