摘要：目的 评价乌司他丁对体外循环(CPB)中内皮细胞的保护作用。方法 择期21例先心病心内畸形矫治术患者，随机分成对照组(A组,n=7)；抑肽酶组(B组,n=7)，给予抑肽酶500万U，CPB前给予1/2量，余加入预充液；乌司他丁组(C组,n=7)，给予乌司他丁2万U/kg，1/3量用于CPB前，1/3加入预充液，另1/3复温时给予。于麻醉后CPB前(T1)、CPB 30min(T2)、停CPB(T3)、停CPB后3h(T4)、24h(T5)、72h(T6)采集静脉血，观察患者血浆中血管性假血友病因子(von Willebrand Factor,vWF)和内皮素-1在该过程中的变化。结果 vWF三组变化趋势一致，T2已开始上升，与T1相比，对照组有非常显著性差异(P<0.01)，抑肽酶组与乌司他丁组有显著性差异(P<0.05)；T3、T4、T5、T6与T1相比，三组都有非常显著性差异(P<0.01)。B组与C组上升幅度较小些，T2与T3两时间点，A组与B组、C组比较差异有显著性(P<0.01与P<0.05)。CPB时ET-1有增高趋势，A组T2已明显上升，CPB后3h达高峰，以后有下降趋势，但CPB后72h仍高于CPB前(P<0.05)。B组与C组ET-1总体无增高趋势。结论 CPB可导致血管内皮细胞的广泛激活/损伤，CPB导致的某些继发因素使此损伤持续数天；乌司他丁对CPB中内皮细胞有一定的保护作用。

    关键词：体外循环；乌司他丁；内皮；血管性假血友病因子；内皮素-1

    Effects of Ulinastatin on Vascular Endothelial Cells During Cardiopulmonary Bypass in Patients Undergoing Open Heart Surgery

    JIANG Xiao-fen, CHI Sheng-ying, JIN Lie-lie，Sun Cheng-chao

    ( 1.Department of Anaesthesiology,2.Medical Laboratory，3.Department of Cardiothorac Surgery,First Affiliated Hospital of Wenzhou Medical College Zhejiang Wenzhou 325000,China)

    Abstract: OBJECTIVE To investigate the effects of ulinastatin on vascular endothelial cells in patients undergoing open heart surgery with cardiopulmonary bypass(CPB). METHODS Twenty-one patients with cardiac function class I~II schedualed for congenital heart disease were randomly divided into three groups:control group(group A, n=7); aprotinin group(group B, n=7)),2500000 unit aprotinin were given intravenously before CPB and same amount of aprotinin added into the priming solution;ulinastatin group (group c, n=7),total of 20000 unit/kg ulinastatin were given intravenously before CPB, the priming solution and during rewarm.Blood samples were taken before CPB(T1), 30min following CPB(T2),immediately after discontinuing bypass(T3),3h after the termination of CPB (T4),24h(T5) and 72h(T6) respectively,for determination of von Willebrand Factor(vWF) and endothelin-1(ET-1).RESULTS The level of vWF significantly elevated during CPB and after CPB in all groups. The levels of vWF were lower at T2 and T3 in group B and group C(P<0.01 or P<0.05).The plasma level of ET-1 increased significantly during and after CPB in group A(P<0.01), reached to its top to 3h after discontinuing bypass, and did not return to nomal 72h after the termination of CPB (P<0.05). While in group B and group C the concentration of plasma ET-1 did not varied significantly. CONCLUSION There were severe endothelial cell damage during CPB,the damage can continued over 72h after the termination of CPB. Ulinastatin is effective in reducing CPB-induced endothelial cell damage. ......