The pulmonary protective effect of low-dose aprotinin during cardiopulmonary bypass / 中华麻醉学杂志

ABSTRACT

ve To evaluate the protective effect of low-dose aprotinin on lungs from acute injury induced by cardiopulmonary bypass(CPB).Methods Twenty-eight ASA II-III patients (13 male, 15 female) aged (40.39?8.51) years, weighing (56.79?7.61) kg scheduled for elective valve replacement, were divided into two groups of 14 each control group and aprotinin group. Patients who had infectious disease or received glucocorticoid before operation were excluded. The mean duration of CPB was (127.93?52.96) min and the mean aortic cross-clamping time was (68.54?30.71) min.The patients were premedicated with intramuscular phenobarbital 0.1 and scopolamine 0.3 mg. Anesthesia was induced with midazolam 0. 1-0.2mg?kg, fentanyl 10-20?g,kg-1 and intubation was facilitated with vecuronium 0.1-0.12 mg?kg-1. Radial artery and right internal jugular vein were cannulated for direct BP and CVP monitoring. Anesthesia was maintained with intermittent boluses of fentanyl and vecuronium supplemented with enflurane inhalation. The patients were mechanically ventilated. Tidal volume was maintained at 10-12 ml?kg , respiratory rate 12 bpm and IE ratio 12.In aprotinin group 1 ? 10~6KIU of aprotinin was added to the priming solution, 1 ? 10~6 KIU aprotinin was infused after induction of anesthesia until thoracotomy and 2.5 ? 105KIU.h-1 was infused from thoracotomy until the end of surgery. In control group aprotinin was replaced by same volume of lactated Ringer solution. Peripheral blood samples were taken before induction of anesthesia, before CPB and 1,24 h after termination of CPB, for determination of IL-10 and TNF-?. Respiratory index [P( A-a)DO2/PaO2] was calculated before CPB, 10 min and 60 min after CPB. Results There was no significant difference in age, weight, duration of operation CPB time and aortic cross-clamping time between the two groups. The TNF-? concentration was not significantly different before induction of anesthesia and CPB between the two groups. But at 1 and 24 h after CPB TNF-? level was significantly higher than the baseline value before anesthesia in control group and that in aprotinin group. The IL-10 concentration greatly increased at 1 h after CPB in both groups as compared with that before anesthesia, but was much higher in the aprotinin group than that in the control group. Respiratory index at 10 min and 60 min after CPB was higher than the baseline value in control group andthat in the aprotinin group (P