乌司他丁对紫绀患儿心脏手术围术期的肺保护作用及术后7年随访
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摘要
目的评价乌司他丁对紫绀小儿心脏手术围术期的肺保护作用的影响,并进行术后7年随访。方法本研究为回顾性队列研究。选取本院于2010年1月至12月接受法洛四联症(TOF)矫治术的单纯TOF患儿184例。根据术中是否应用乌司他丁被分为两组:对照组(n=77)和乌司他丁组(n=107),年龄2个月～12岁,ASAⅡ～Ⅲ级,术后7年对患儿及家属进行随访。记录并统计分析患儿术后近远期不良事件的发生率和死亡率。结果与对照组比较,乌司他丁组的术后总出血量显著减少,差异有统计学意义(P=0.01)。与对照组比较,乌司他丁组术后延迟拔管的发生率显著减少,差异有统计学意义(P=0.02)。两组患者间住院肾功能衰竭发生率和死亡率的差异无统计学意义(P>0.05)。术后7年两组患者肾功能衰竭和死亡的发生率差异无统计学意义(P>0.05)。结论乌司他丁可显著降低紫绀患儿心脏术后总出血量和术后延迟拔管的发生率,具有肺保护作用,对近、远期肾功能衰竭的发生率和死亡率没有影响。
Objective To investigate the pulmonary protective effect of ulinastatin in pediatric patients undergoing radical surgery for tetralogy of Fallot( TOF) and its long-term outcomes. Methods The study was an observational cohort study. During January2010 to December 2010,184 consecutive patients aged from 2 months to 12 years old who received radical surgery for TOF in Fuwai hospital were enrolled in the study. They were divided into two groups: the control group( n = 77) and the ulinastatin group( n = 107).They were followed up for seven years. The morbidity and mortality were recorded and analyzed. Results Compared with the control group,patients in the ulinastatin group showed a significantly lower postoperative blood loss( P = 0.01) and a less prolonged mechanical ventilation( P = 0.02). There was no significant difference in postoperative and long-term mortality and morbidity between the two groups( P >0.05). Conclusion Ulinastatin might decrease the postoperative blood loss and the incidence of prolonged mechanical ventilation. Moreover,ulinastatin did not affect the short-term and long-term incidence of renal failure and mortality in pediatric patients with cyanosis undergoing cardiac surgery.
Objective To investigate the pulmonary protective effect of ulinastatin in pediatric patients undergoing radical surgery for tetralogy of Fallot( TOF) and its long-term outcomes. Methods The study was an observational cohort study. During January2010 to December 2010,184 consecutive patients aged from 2 months to 12 years old who received radical surgery for TOF in Fuwai hospital were enrolled in the study. They were divided into two groups: the control group( n = 77) and the ulinastatin group( n = 107).They were followed up for seven years. The morbidity and mortality were recorded and analyzed. Results Compared with the control group,patients in the ulinastatin group showed a significantly lower postoperative blood loss( P = 0.01) and a less prolonged mechanical ventilation( P = 0.02). There was no significant difference in postoperative and long-term mortality and morbidity between the two groups( P >0.05). Conclusion Ulinastatin might decrease the postoperative blood loss and the incidence of prolonged mechanical ventilation. Moreover,ulinastatin did not affect the short-term and long-term incidence of renal failure and mortality in pediatric patients with cyanosis undergoing cardiac surgery.
引文
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[9]于浩,颜涛,马涛,等.乌司他丁对复杂先天性心脏病患儿体外循环围术期肺保护作用的研究[J].广东医学,2017,38(20):3184-3187.
[10] Wan X,Xie X,Gendoo Y,et al. Ulinastatin administration is associated with a lower incidence of acute kidney injury after cardiac surgery:a propensity score matched study[J]. Crit Care,2016,20:42.
[2] Tabib A,Abrishami SE,Mahdavi M,et al. Predictors of prolonged mechanical ventilation in pediatric patients after cardiac surgery for congenital heart disease[J]. Res Cardiovasc Med,2016,5(3):e30391.
[3] Zhang Y,Zeng Z,Cao Y,et al. Effect of urinary protease inhibitor(ulinastatin)on cardiopulmonary bypass:a meta-analysis for china and japan[J]. PLoS One,2014,9(12):e113973.
[4] He QL,Zhong F,Ye F,et al. Doesintraoperative ulinastatin improve postoperative clinical outcomes in patients undergoing cardiac surgery:a meta-analysis of randomized controlled trials[J]. Biomed Res Int,2014,2014:630835.
[5] Xu HY,Rong XS,Wang DP,et al. Effect of urinary trypsin inhibitor on inflammatory cytokines and organ function in patients with cardiopulmonary bypass[J]. Eur Rev Med Pharmacol Sci,2017,21(9):2220-2225.
[6] Martin K,Breuer T,Gertler R,et al. Tranexamic acid versusε-aminocaproic acid:efficacy and safety in paediatric cardiac surgery[J]. Eur J Cardiothorac Surg,2011,39(6):892-897.
[7] Kwiatkowski DM,Goldstein SL,Cooper DS,et al. Perit oneal dialysis vs furosemide for prevention of fluid overload in infants after cardiac surgery:a randomized clinical trial[J]. JAMA Pediatr,2017,171(4):357-364.
[8] Siemens K,Sangaran DP,Hunt BJ,et al. Strategies for prevention and management of bleeding following pediatric cardiac surgery on cardiopulmonary bypass:a scoping review[J]. Pediatr Crit Care Med,2018,19(1):40-47.
[9]于浩,颜涛,马涛,等.乌司他丁对复杂先天性心脏病患儿体外循环围术期肺保护作用的研究[J].广东医学,2017,38(20):3184-3187.
[10] Wan X,Xie X,Gendoo Y,et al. Ulinastatin administration is associated with a lower incidence of acute kidney injury after cardiac surgery:a propensity score matched study[J]. Crit Care,2016,20:42.