The Influence Of The Ulinastatin On The Inflammatory Cytokines And Lung Function After Extracorporeal Circulation In The Infants Of Ventricular Septal Defect

Objective:Cardiopulmonary bybass was an important auxiliary technique in open heart surgery.Cardiopulmonary bybass had changed a lot in equipment,theory and clinical application in the past 60 years,but it still had postoperative complications,such as lung injury.As a proteasome inhibitor,ulinastatin had shown inhibition on inflammation and protection on lung function.The research of ulinastatin used in CPB was also very extensive,but there were not many reports about infants and young children.We investigated the effect of ulinastatin in the open heart operation of children with congenital heart disease in this study.By the means of the determination of neutrophil elastase,TNF-α and IL-6,and the monitoring of respiratory index and oxygenation index,we study about the protection of lung function for ulinastatin in cardiopulmonary bybass.Methods:We randomly divided the 50 patients of ventricular septal defect into two equal groups : experimental group(U)and control group(C).The requirements for all the patients into the group are the Ⅰor Ⅱ leve ASA classificationl,2 ~ 6 months old and 3 kg ~ 6 kg weight.The same anesthesia method and vitro and operation steps were used for all the patients.Experimental group: 20000 U/kg ulinastatin were diluted to 10 ml with physiological saline.5ml of the diluent was mainlined into central venous before the arterial cannula.The other 5ml was added to the piercing of extracorporeal circulation fluid and then mainlined into the body.Control group(C): only with normal saline instead for the 10 ml diluent.The quantity of the NE,TNF-α and IL-6 were measured by the euzymelinked immunosorbent assay(Elisa)with the 4ml internal jugular venous blood before the operation(T0),at the time of the vena cava open(T1),4 hours after the CPB(T2)and 24 hours after the CPB(T3).The measure of respiratory function: we measured the blood gas analysis of 1ml radial artery blood at the time of T0~T3.We recorded the PaO2,PaCO2,Hct and Fi O2 and then calculated the respiratory index(RI)and oxygenation index(OI)with the formula.Results:There were no statistically significant in the level of the NE,TNF-α,IL-6 and the measured value of the RI and OI between the two groups at T0.(P>0.05)The level of the NE,TNF-α and IL-6 of two groups were higher at T1 ~ T3 than T0(P<0.05).The measured value of the RI in two groups was more and the measured value of the OI was lesser at T1~T3 than T0(P<0.05).Compared with Control group(C),the level of the NE,TNF-αand IL-6 in the experimental group(U)were lower at T1 ~ T3.The measured value of the RI was lesser and then the measured value of the OI was more at T1~T3 than T0 in the experimental group(U)(P<0.05).Concluions :1 Cardiopulmonary bybass could promote the release of inflammatory mediators and neutrophil elastase,resulting in pulmonary function injury.2 Ulinastatin can inhibit the release of inflammatory mediators and neutrophil elastase in infants after cardiopulmonary bybass,protecting pulmonary function.