ABSTRACT
Objective To investigate the effect of ulinastatin combined pantoprazole on inflammatory factors and gastrointestinal tract in patients undergoing cardiopulmonary bypass ( CBP) cardiac surgery. Methods A total of 200 patients who suffered rheumatic heart disease were scheduled for valve replacement surgery with CPB, were randomly divided into four groups:control group (CON),ulinastatin (UTI),pantoprazole groups (PTZ) and ulinastatin+pantoprazole groups(UTI+PTZ),50 cases in each group.Before CBP,group UTI was given ulinastatin 10 000 U·kg-1,group PTZ was given pantoprazole 40 mg,group UTI+PTZ was given ulinastatin 10 000 U·kg-1and pantoprazole 40 mg,group CON was given 0.9% sodium chloride soution.The gastric mucosa pHi and blood samples would be collected in all four groups at the preoperative (t1),CPB 30 min (t2),after CBP (t3),6 h after surgery (t4),24 h (t5) five time points.The IL-6 and TNF-α would be detected by enzyme linked immunosorbent (ELISA) method,and abdominal distension,abdominal pain,hematemesis,black and defecate occult blood test positive for digestive tract related complications would be collected after the surgery 1,2 days. Results The concentration of TNF-α and IL-6 at t2,t3, t4,t5were higher than those at t1in all four groups(P<0.05).Compared with CON group,the concentration of TNF-α and IL-6 at t2, t3,t4,t5in UTI,PTZ and UTI+PTZ group were significantly decreased (P<0.05).The concentration of TNF-α and IL-6 in UTI and UTI+PTZ group were better than in PTZ group.The pHi at t2,t3,t4was lower than that at t1in four groups(P<0.05),and pHi at t5 was obviously lower than that at t1in group CON (P<0.05).The pHi at t2,t3,t4in UTI,PTZ and UTI+PTZ group was higher than that in CON group ( P<0. 05), and pHi in UTI+PTZ group was better than that in UTI and PTZ group. The postoperative gastrointestinal complications in CON group were higher than those in UTI,PTZ and UTI+PTZ group (P<0.05). Conclusion Ulinastatin combined with pantoprazole for patients undergoing CPB heart surgery,can significantly reduce the release of TNF-α and IL-6、increase gastric pHi and reduce the incidence of gastrointestinal complications.
ABSTRACT
Objective To investigate the changes in metabolic indexes and anesthesia administration during perioperation in patients undergoing orthotopic liver transplantation. Methods Eleven patients who underwent orthotopic liver transplantation were selected. Their pH, BE, HCO 3 -, K +, Ca 2+, blood glucose, PT, APTT and FIB were assessed at 60 min of pretransplantation, 20 min and 40 min of liver transplantation, 20 min and 40 min of new liver reperfusion. Results The pH, BE, HCO 3 -, K +, Ca 2+ during 20 min and 40 min of liver transplantation decreased more significantly than those during pretransplantation 60 min, PT and APTT extended markedly, the level of blood glucose did not change markedly; pH, BE, HCO 3-, K +, Ca 2+ and the level of blood glucose during new liver reperfusion 20 min and 40 min increased significantly compared to those during liver transplantation 20 min and 40 min; PT, APTT and FIB did not change markedly. Conclusion Metabolic indexes during liver transplantation change more markedly than those during pretransplantation or new liver reperfusion.