Effects of ulinastatin on cytoldnes and respiratory index during open heart surgery with CPB / 中华麻醉学杂志

ABSTRACT

Objective To investigate the effects of ulinastatin on pro- and anti-inflammatory cytokines and respiratory index during open heart surgery under CPB. Methods Twenty ASA Ⅱ- Ⅲ patients of either sex (9 males, 11 females) scheduled for elective valve replacement under CPB were randomly divided into two groups of 10 each control group (C) and ulinastatin group (W) . Patients with hepato-renal dysfunction or taking glucocorticoid were excluded. The patients were premedicated with intramuscular phenobarbital 0.1 g and scopolamine 0.3 mg. Anesthesia was induced with midazolam 0.1 mg?kg-1 , fentanyl 10?g?kg-1 and vecuronium 0.1mg?kg-1 . After tracheal intubation anesthesia was maintained with midazolam and fentanyl. The patients were mechanically ventilated. VT was set at 8-12 ml?kg-1 , RR 10-12 bpm and I E 12. PETCO2 was maintained at 35-45 mg. In ulinastatin group, the patients received ulinastatin 12 000 U?kg-1 of which half was given i.v. before CPB and half was added to the priming fluid, while group C received normal saline instead of ulinastatin. Blood samples were taken from radial artery for determination of plasma TNF-?, IL-6, and IL-10 concentrations and blood gas analysis before operation (T1 ) , 30 min after initiation of CPB (T2), 1 h (T3 ) , 4 h (T4 ) and 24 h (T5 ) after CPB. Respiratouy index (PA-aDO2/ PaO2) was calculated at T1-5 .Results There were no significant differences in sex, age, weight, height, duration of CPB, and aortic cross-clamping time between the two groups. In group C the plasma levels of TNF-?, IL-6 and IL-10 were significantly higher than the baseline values (T1 ) during and after CPB (P