乌司他丁对小儿体外循环术后凝血功能的影响

Effects of ulinastatin on coagulation in children after cardiopulmonary bypass

摘要:

目的：观察乌司他丁对小儿体外循环（CPB）术后凝血功能的影响。方法：50例行心内直视修补术的单纯室间隔缺损患儿随机分为两组：乌司他丁组和对照组。乌司他丁组在CPB预充液中加入乌司他丁1.0×104 U/kg。选择肝素化前、CPB结束后1 h、6 h、24 h共4个时间点，检测患儿的凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）等凝血指标。结果：与对照组比较，乌司他丁组PT在CPB结束后 1 h（18.7±0.7 s vs 15.5±0.5 s）及6 h（17.5±0.6 s vs 15.0±0.6 s）显著延长；APTT在CPB结束后6 h（38.7±3.1 s vs 35.3±3.1 s）及24 h（34.2±3.0 s vs 31.1±2.6 s）显著延长（P<0.05）。结论：乌司他丁可引起患儿CPB术后PT及APTT延长，影响凝血状态。

Abstract:

OBJECTIVE: To study the effects of ulinastatin on coagulation in children who underwent open-heart surgery with cardiopulmonary bypass (CPB). METHODS: Fifty children who underwent open-heart surgery for ventricular septal defect were randomly divided into two groups: ulinastatin treatment and control. Before CPB, ulinastatin (1.0×104 U/kg) was added to CPB priming fluid only in the ulinastatin treatment group. Activated partial thromboplasin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen and international normalized ratio (INR) were measured both before and at 1 hr, 6 hrs and 24 hrs after CPB. RESULTS: The PT in the ulinastatin group was more prolonged than in the control group at 1 hr after CPB (18.7±0.7 s vs 15.5±0.5 s) and 6 hrs after CPB (17.5±0.6 s vs 15.0±0.6 s). The APTT in the ulinatatin group was also significantly more prolonged than in the control group at 6 hrs after CPB (38.7±3.1 s vs 35.3±3.1 s) and 24 hrs after CPB (34.2±3.0 s vs 31.1±2.6 s). CONCLUSIONS: Ulinastatin may prolong PT and APTT after CPB, and thus affects coagulation in children.