Protective effect of ulinastatin on erythrocyte in patients undergoing open heart surgery with cardiopulmonary bypass / 中华麻醉学杂志

ABSTRACT

Objective To investigate the protective effect of ulinastatin on erythrocyte in patients undergoing open heart surgery with cardiopulmonary bypass (CPB) .Methods Twenty NYHA class Ⅱ-Ⅲ patients (10 male, 10 female) aged 16-66 yr undergoing elective valve replacement under CPB were randomly divided into two groups: ulinastatin group (U, n = 10) and control group (C, n = 10) . Patients with hepato-renal disease, hyperlipoproteinemia, respiratory dysfunction, blood diseases or pulmonary hypertension were excluded. The patients were premedicated with intramuscular morphine 0.08 mg ? kg-1 and scopolamine 0.006 mg?kg-1 . Anesthesia was induced with midazolam 0.1 mg?kg-1 , fentanyl 10 ?g?kg-1 and vecuronium 0.1 mg?kg-1 and maintained with intravenous midazolam and fentanyl. In group U the patients received ulinastatin 12000 U?kg-1 , of which half was given i.v. before CPB and the other half was added to the priming solution. In control group the patients received normal saline instead of ulinastatin. Blood samples were taken from radial artery before operation (T1), 15 min after initiation of CPB (T2), 15 min (T3) and 30 min (T4) after aortic declamping and 24 h after operation (T5) , for determination of plasma and erythrocyte MDA (P-MDA, E-MDA) levels and erythrocyte SOD (E-SOD) , Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase activities.Results The levels of P-MDA and E-MDA were significantly increased at T2_5 in group C but only at T3 and T4 in group U compared to the baseline at T1 . The levels of P-MDA and E-MDA at T2-5 were significantly higher in group C than in group U. The E-SOD, Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase activities significantly increased at T2 compared to baseline at T1 , then gradually decreased in both groups. They were significantly higher at T3-5 in group U than in group C. Conclusion Ulinastatin can alleviate erythrocyte lipid peroxidation and protect erythrocyte during CPB.