Effects Of Different Doses Of Ulinastatin On Pulmonary Function And Inflammatory Response In Patients With Stanford Type A Aortic Dissection

Objective:To investigate the effects of different doses of ulinastatin?UTI?on oxygenation index?OI??alveolar-arterial oxygen pressure difference(P_?A-a?O₂)and serum inflammatory factors within 48h after cardiopulmonary bypass?CPB?initiation on patients with Stanford type A aortic dissection?AAD?;and to study the effects of different doses of ulinastatin on patients'outcomes during hospitalization.Methods:Fifty-eight patients who undergoing AAD surgery in Tianjin Chest Hospital from March 2018 to February 2019 were enrolled and randomly divided into three groups:low-dose group?Group L,n=22?,high-dose group?Group H,n=18?and control group?group C,n=18?.Patients in Group L and Group H,received a total dose of 20,000U/kg and 30,000 U/kg UTI,respectively.Half of the dose was administered before surgical incision,and the rest was was given at the beginning of CPB,while Group C was given same volume of normal saline at same time.Serum interleukin-6?IL-6?,interleukin-8?IL-8?,interleukin-10?IL-10?and tumor necrosis factor-??TNF-??levels were measured after anesthetic induction?T₀?,3h?T₁?,6h?T₂?,12h?T₃?,24h?T₄?,and 48h?T₅?after initiation of CPB.The pulmonary data,such as OI and(P_?A-a?O₂)were obtained at each time points except T₁ for the reason of without weaning from CPB.Patients'infusion volume?including crystal and colloid volume?and transfusion volume?containing red blood cell,plasma,platelet,platelet-rich plasma and autologous blood volume?were recorded.In addition,the length of mechanical ventilation,ICU stay and hospital stay,as well as postoperative morbidity and mortality during hospitalization were also recorded.Results:The proportion of patients with preoperative COPD in group H was higher than other groups,and the percentage of patients who received surgery within48h after onset of AAD in Group H was higher than other groups?P<0.05?.The serum level of IL-6 and TNF-?were significantly lower in Group H and Group L than group C from T₁ to T₃,and the IL-8 level in Group H was also significantly lower than control group at the same time points?P<0.05?.The OI from T₂ to T₄ in Group L was better than that in Group C,it was also better than in Group H at T₂?P<0.05?.In addition,the P_?A-a?O₂ at T₄ in Group L was lower than that in Group C?P<0.05?.There were no significant differences in volume of infusion and transfusion among three groups?P>0.05?,and there were no statistical differences in mechanical ventilation time,length of ICU stay and postoperative hospital stay as well as the postoperative morbidity and mortality during hospitalization among the three groups?P>0.05?.Conclusion:Compared with a total dose of 30,000 U/kg ulinastatin,patients with Stanford type A aortic dissection received a total dose of 20,000 U/kg of ulinastatin after induction and during cardiopulmonary bypass,respectively,could improve oxygenation index within 24h after initiation of CPB,which may be related to the inhibition of perioperative inflammatory factor release by ulinastatin.