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【摘要】 目的 探討乌司他丁治疗冠状动脉（冠脉）搭桥手术术后患者血清炎性应激反应以及心肾功能影响。 方法 120例冠心病行冠脉搭桥手术患者， 按入院先后随机分为观察组与对照组， 各60例。两组患者均给予规范术后管理， 在此基础上观察组患者术后给予乌司他丁治疗， 对照组患者给予等剂量生理盐水治疗。分别于治疗前后检测血清肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）、肌酸激酶同工酶（CK-MB）、血浆钠尿肽（BNP）、胱抑素-C（CysC）， 比较两组患者术后肺部感染、心房纤颤、室上性心动过速、短阵性室性心动过速等并发症发生率。结果 治疗后， 观察组患者血清CK-MB、BNP、CysC水平分别为（32.18±4.28）U/L、（458.79±56.28）pg/ml、（1.53±0.43）mg/L， 均低于对照组的（38.79±5.05）U/L、

（587.61±65.29）pg/ml、（1.89±0.51）mg/L， 差异有统计学意义（P<0.05）。 治疗后， 观察组患者血清TNF-α、IL-6水平分别为（18.67±3.28）、（19.86±4.38）pg/ml， 均低于对照组的（23.17±4.08）、（25.38±5.60）pg/ml，

差异有统计学意义（P<0.05）。 观察组患者临床并发症发生率均低于对照组， 差异有统计学意义（P<0.05）。结论 冠脉搭桥术后应用乌司他丁治疗， 可减少炎性， 保护心肾功能， 减少术后并发症发生率。分析原因与其下调机体炎性反应水平有关。

【关键词】 冠状动脉搭桥手术；炎性损伤；应激反应；乌司他丁

DOI：10.14163/j.cnki.11-5547/r.2017.01.045

Analysis on effect of ulinastatin on inflammatory stress response and heart and kidney injury for patients with coronary artery bypass grafting ZHAO Wen-dong. Inner Mongolia Autonomous Region Peoples Hospital， Hohhot 010017， China

【Abstract】 Objective To explore effect of ulinastatin on inflammatory stress response and heart and kidney injury for patients with coronary artery bypass grafting. Methods A total of 120 patients with coronary artery bypass grafting were divided by admission order into observation group and control group， with 60 cases in each group. Both groups received specification of postoperative management， and the observation group also received ulinastatin after operation for treatment， while the control group receive isodose physiological saline for treatment. Detection were made on tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， creatine kinase isoenzyme （CK-MB）， plasma brain natriuretic peptide （BNP） and cystatin-C （CysC） before and after operation. Comparison were made on incidence of complications， such as postoperative pulmonary infection， atrial fibrillation， supraventricular tachycardia and short paroxysmal ventricular in two groups. Results After treatment， the observation group had serum CK-MB， BNP and CysC level respectively as （32.18±4.28） U/L， （458.79±56.28） pg/ml

and （1.53±0.43） mg/L， which were all lower than （38.79±5.05） U/L， （587.61±65.29） pg/ml and （1.89±0.51） mg/L

in the control group， and their differences had statistical significance （P<0.05）. After treatment， the observation group had serum TNF-α and IL-6 level respectively as （18.67±3.28） and （19.86±4.38） pg/ml， which were all lower than （23.17±4.08） and （25.38±5.60） pg/ml in the control group， and their differences had statistical significance （P<0.05）. The observation group had lower incidence of clinical complications than the control group， and the difference had statistical significance （P<0.05）. Conclusion Implement of ulinastatin after coronary artery bypass grafting can reduce inflammation response， protect heart and kidney function， and decrease incidence of postoperative complications， which may related to its lower the bodys inflammatory response level.

【Key words】 Coronary artery bypass grafting； Inflammation damage； Stress response； Ulinastatin

冠脉搭桥手术后患者手术应激损伤可以进一步损伤心肌细胞， 加重心脏负荷， 造成临床心力衰竭发生率增加， 加重了围手术期患者病死率风险[1]。乌司他丁是蛋白酶抑制剂， 对于体内多种溶酶具有抑制作用， 既往研究主要应用于急性胰腺炎的治疗， 对于冠脉搭桥术后应用尚缺乏分析[2]。研究应用乌司他丁治疗120例冠脉搭桥术后患者， 观察其对于血清炎性应激反应以及心肾功能影响的临床疗效， 现报告如下。……