| 郑浏璞,沈海俭,蒋柳明,金建国,王良荣,林丽娜.乌司他丁对肢体缺血再灌注致肺功能损伤防护效果研究[J].浙江中西医结合杂志,2013,23(2):88-94 |
| 乌司他丁对肢体缺血再灌注致肺功能损伤防护效果研究 |
| Protective Effects of Ulinastatin Injection on Lung Injury Induced by Limb Ischemia Reperfusion in Pa?tients Undergone Lower Limb Surgery |
| 投稿时间：2012-08-10 |
| DOI： |
| 中文关键词: 肢体缺血再灌注
肺功能
乌司他丁 |
| 英文关键词:limb ischemia reperfusion
pulmonary function
ulinastatin |
| 基金项目:浙江省中医药科研基金计划（No:2010ZA087） |
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| 中文摘要: |
| 目的：观察乌司他丁对肢体缺血再灌注（LIR）致肺功能损伤的防护效果并探讨其保护机
制。方法: 选择应用止血带的下肢手术病例30例，随机分为对照组和乌司他丁组，各15例。对照
组在上止血带前10min静滴生理盐水100mL；乌司他丁组则在相同时间内静滴乌司他丁注射液
（0.6×104U/kg）100mL，于上止血带前（T0）、上止血带后1h（T1）、松止血带后0.5h（T2）、2h（T3）、6h
（T4）、24h（T5）取血进行血气分析，计算P（A-a）DO2和OI值，并测定血浆中NO、ET-1、IL-6浓度
值。结果: 对照组在T4时点P（A-a）DO2值较T0点增大（P<0.01），乌司他丁组各时点组内变化无统
计学意义（P>0.05）；乌司他丁组T4时点的差值增大幅度小于对照组（P<0.05）。各组OI值变化与P
（A-a）DO2值相反，而两组PaCO2值在T2、T3时都有升高（P<0.01），T4时点恢复，且两组间差异无统
计学意义（P>0.05）。两组T1、T2、T3、T4时血浆NO浓度下降，乌司他丁组下降幅度小于对照组，且
在T3、T4时NO浓度高于对照组（P<0.01）。而两组血浆ET-1、IL-6浓度变化则刚好相反。结论：乌
司他丁通过抑制炎性细胞与血管内皮细胞黏附、抑制ET-1释放、减轻NO消耗、抑制体液炎性因子
的过度作用，减轻肢体缺血再灌注对肺的损伤，改善LIR后的肺氧合功能。 |
| 英文摘要: |
| Objective: To investigate the protective effects of ulinastatin injection on acute lung injury induced
by limb ischemia reperfusion. Methods: Thirty patients undergoing lower limb surgery were intravenously adminis?
tered ulinastatin (0.6×104U/kg,100mL, group U) or saline (100 ml, group C) at 10 minutes before application of
tourniquet. P(A-a)DO2 and oxygenation index (OI) were calculated by measuring PO2 and PaCO2 from blood gas
analysis and nitrous oxide, endothelin-1, and IL-6 concentrations were determined from plasma samples before an?
esthesia(T0), 1h after tensing the tourniquet(T1), and 30min(T2), 2h (T3), 6h (T4), and 24h (T5) after releasing
the tourniquet. Results: P(A-a)O2 was elevated in T4 when compared with T0 in group C (P<0.01). P(A-a)O2 re?
mained stable at each time point in group U and was lower at T4 than that in group C (P<0.05). OI decreased
in both groups. PaCO2 increased at T2 and T3 (P<0.01) and the increase disappeared at T4 in both groups, with?
out a significant difference of PaCO2 at T4 between the 2 groups (P>0.05). NO concentration was reduced from
T1 to T4 after limb ischemia reperfusion in both groups, but the range of decrease was smaller in group U than
that in group C, with a significantly higher NO concentration at T3 and T4 in group U than that in group C (P<
0.01). The alteration of ET-1 and IL-6 concentrations was opposite to NO. Conclusions: Ulinastatin Injection
can alleviate lung injury after limb injury reperfusion by inhibiting endothelin-1 liberation and IL-6 expression
and reducing the expansion of nitrous oxide. |
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