乌司他丁后处理对心脏瓣膜置换患者C反应蛋白及基质金属蛋白酶-9表达的影响

发布时间：2018-06-02 11:22

本文选题：心脏瓣膜置换 + 乌司他丁　；参考：《中国老年学杂志》2017年22期

【摘要】：目的探讨乌司他丁后处理对心脏瓣膜置换患者C反应蛋白(CRP)及基质金属蛋白酶(MMP)-9表达的影响。方法心脏瓣膜置换术患者130例根据随机抽签原则分为治疗组与对照组各65例,两组都给予择期心脏瓣膜置换术,在体外循环前对照组给予氨基己酸进行后处理保护,治疗组给予乌司他丁后处理保护。结果两组T1时间点CRP与MMP-9表达量无统计学差异(P0.05),且在T2时间点都呈现最高水平表达,在T3时间点有明显下降(P0.05),治疗组T2与T3时间点CRP与MMP-9表达量明显低于对照组(P0.05)。两组T2与T3时间点部分活化凝血活酶时间(APTT)与血浆凝血酶原时间(PT)均明显高于T1时间点(P0.05),同时治疗组T2与T3时间点APTT与PT明显高于对照组(P0.05),两组T1时间点APTT与PT无统计学差异(P0.05)。两组肝素与鱼精蛋白用量对比无统计学差异(P0.05),治疗组气管导管拔除时间和ICU停留时间明显少于对照组(P0.05)。两组术后均无心包填塞、严重心律失常等严重并发症发生,两组阵发性心房颤动、胸腔积液、肺不张、肺纹理增粗等并发症发生率无统计学差异(P0.05),对症处理后均好转出院。结论心脏瓣膜置换患者在体外循环时伴随有CRP与MMP-9高表达,乌司他丁后处理能有效抑制其高表达,同时能维护机体凝血功能的平衡性,促进患者康复,安全性好。
[Abstract]:Objective to investigate the effects of ulinastatin postconditioning on the expression of C-reactive protein (CRP) and matrix metalloproteinase (MMP-9) in patients with cardiac valve replacement. Methods 130 patients with cardiac valve replacement were divided into treatment group (n = 65) and control group (n = 65) according to the principle of random drawing. Both groups were given selective cardiac valve replacement, and the control group was treated with amino-caproic acid before cardiopulmonary bypass (CPB). The treatment group was given ulinastatin post-treatment protection. Results there was no significant difference in the expression of CRP and MMP-9 between the two groups at T 1 time point, and the expression of CRP and MMP-9 was the highest at T 2 time point, and decreased significantly at T 3 time point. The expression of CRP and MMP-9 in treatment group was significantly lower than that in control group at T 2 time point and T 3 time point. The plasma prothrombin time and partial activated thromboplastin time (APTT) of the two groups were significantly higher than those of the T 1 time point (P 0.05), while the APTT and PT of the treatment group at T 2 and T 3 time points were significantly higher than those of the control group (P 0.05). There was no significant difference between the two groups in APTT and PT at T 1 time point (P 0.05). There was no significant difference in the dosage of heparin and protamine between the two groups. The tracheal catheter extubation time and ICU residence time in the treatment group were significantly lower than those in the control group (P 0.05). There were no pericardial tamponade, severe arrhythmia and other serious complications in the two groups. There was no significant difference in the incidence of paroxysmal atrial fibrillation, pleural effusion, atelectasis, and thickening of lung, etc. There was no significant difference between the two groups in the incidence of complications such as pericardial tamponade and severe arrhythmia. Conclusion the high expression of CRP and MMP-9 was observed in patients with cardiac valve replacement during cardiopulmonary bypass. Ulinastatin post-treatment could effectively inhibit the high expression of Ulinastatin, maintain the balance of coagulation function and promote the recovery of patients.
【作者单位】：甘肃省人民医院心血管外科;河北医科大学第二医院;
【基金】：2013年河北省卫生厅课题(No.20130472)
【分类号】：R654.2

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