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Effect of ulinastin on the gastrointestinal circulation and systemic inflammatory response during cardiopulmonary bypass

Chang Ye-tian

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Abstract

Objective To investigate the effect of ulinastin on the gastro-intestinal circulation and systemic inflammatory response during open heart surgery with cardiopulmonary bypass( CPB) .Methods Thirty adult patients undergoing valve replacement with mild hypothermic CPB were randomly divided into two groups: ulinastin group (U ,n = 15) and control group (C , n = 15). In ulinastin group patients received ulinastin 6000 IU·kg-1iv after induction of anesthesia and another 6000 IU·kg-1 was added into the priming solution. In control group patients received equal volume of normal saline, instead of ulinastin. The patients were premedicated with morphine 0.2 mg·kg-1 and scopolamine 0.06 mg·kg-1 .Ranitidine 1 mg·kg-1 was given iv before induction of anesthesia. Anesthesia was induced with midazolam 0.1 mg·kg-1 , fentanyl 10μg·kg-1 and vecuronium 0.1 mg·kg-1 and maintained with fentanyl 50-60μg·kg-1, midazolam, isoflurane and vecuroinum. The patients were intubated and mechanically ventilated. PET CO2 was maintained at 35-45 mm Hg during operation. Gastric intramucosal PCO2 (PiCO2 ) was measured (pHi was calculated) and blood concentrations of TNF-αand IL-6 were determined before CPB (T0), 30 min after aorta was cross-clamped (T1), 60 min after termination of CPB(T2 ) and 6 h after operation (T3 ) .Results The two groups were comparable with regard to age, sex, body weight, ejection fraction, duration of CPB and cross-clamping time. (1) pHi decreased significantly at T1-2 as compared with the baseline value at T0 (P 0.01) and returned to the baseline level at T3 in both groups. pHi was significantly higher at T1-3 in ulinastin group than that in control group (P0.05).(2) Plasma TNF-a and IL-6 concentrations increased significantly at T1-3 in both groups as compared with the baseline value and were significantly lower at T1-3 in ulinastin group than those in control group. Conclusion Ulinastin can improve gastrointestinal microcirculation during CPB and effectively attenuate CPB-induced acute systemic inflammatory response.

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Objective To investigate the effect of ulinastin on the gastro-intestinal circulation and systemic inflammatory response during open heart surgery with cardiopulmonary bypass( CPB) .Methods Thirty adult patients undergoing valve replacement with mild hypothermic CPB were randomly divided into two groups: ulinastin group (U ,n = 15) and control group (C , n = 15). In ulinastin group patients received ulinastin 6000 IU·kg-1iv after induction of anesthesia and another 6000 IU·kg-1 was added into the priming solution. In control group patients received equal volume of normal saline, instead of ulinastin. The patients were premedicated with morphine 0.2 mg·kg-1 and scopolamine 0.06 mg·kg-1 .Ranitidine 1 mg·kg-1 was given iv before induction of anesthesia. Anesthesia was induced with midazolam 0.1 mg·kg-1 , fentanyl 10μg·kg-1 and vecuronium 0.1 mg·kg-1 and maintained with fentanyl 50-60μg·kg-1, midazolam, isoflurane and vecuroinum. The patients were intubated and mechanically ventilated. PET CO2 was maintained at 35-45 mm Hg during operation. Gastric intramucosal PCO2 (PiCO2 ) was measured (pHi was calculated) and blood concentrations of TNF-αand IL-6 were determined before CPB (T0), 30 min after aorta was cross-clamped (T1), 60 min after termination of CPB(T2 ) and 6 h after operation (T3 ) .Results The two groups were comparable with regard to age, sex, body weight, ejection fraction, duration of CPB and cross-clamping time. (1) pHi decreased significantly at T1-2 as compared with the baseline value at T0 (P 0.01) and returned to the baseline level at T3 in both groups. pHi was significantly higher at T1-3 in ulinastin group than that in control group (P0.05).(2) Plasma TNF-a and IL-6 concentrations increased significantly at T1-3 in both groups as compared with the baseline value and were significantly lower at T1-3 in ulinastin group than those in control group. Conclusion Ulinastin can improve gastrointestinal microcirculation during CPB and effectively attenuate CPB-induced acute systemic inflammatory response.

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Available abstract

Objective To investigate the effect of ulinastin on the gastro-intestinal circulation and systemic inflammatory response during open heart surgery with cardiopulmonary bypass( CPB) .Methods Thirty adult patients undergoing valve replacement with mild hypothermic CPB were randomly divided into two groups: ulinastin group (U ,n = 15) and control group (C , n = 15). In ulinastin group patients received ulinastin 6000 IU·kg-1iv after induction of anesthesia and another 6000 IU·kg-1 was added into the priming solution. In control group patients received equal volume of normal saline, instead of ulinastin. The patients were premedicated with morphine 0.2 mg·kg-1 and scopolamine 0.06 mg·kg-1 .Ranitidine 1 mg·kg-1 was given iv before induction of anesthesia. Anesthesia was induced with midazolam 0.1 mg·kg-1 , fentanyl 10μg·kg-1 and vecuronium 0.1 mg·kg-1 and maintained with fentanyl 50-60μg·kg-1, midazolam, isoflurane and vecuroinum. The patients were intubated and mechanically ventilated. PET CO2 was maintained at 35-45 mm Hg during operation. Gastric intramucosal PCO2 (PiCO2 ) was measured (pHi was calculated) and blood concentrations of TNF-αand IL-6 were determined before CPB (T0), 30 min after aorta was cross-clamped (T1), 60 min after termination of CPB(T2 ) and 6 h after operation (T3 ) .Results The two groups were comparable with regard to age, sex, body weight, ejection fraction, duration of CPB and cross-clamping time. (1) pHi decreased significantly at T1-2 as compared with the baseline value at T0 (P 0.01) and returned to the baseline level at T3 in both groups. pHi was significantly higher at T1-3 in ulinastin group than that in control group (P0.05).(2) Plasma TNF-a and IL-6 concentrations increased significantly at T1-3 in both groups as compared with the baseline value and were significantly lower at T1-3 in ulinastin group than those in control group. Conclusion Ulinastin can improve gastrointestinal microcirculation during CPB and effectively attenuate CPB-induced acute systemic inflammatory response.

Key concepts: Anesthesia, Medicine, Fentanyl, Cardiopulmonary bypass, Midazolam, Isoflurane, Saline, Sedation

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Effect of ulinastin on the gastrointestinal circulation and systemic inflammatory response during cardiopulmonary bypass — Research Paper | ScholarLens