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The Journal of Cardiovascular Surgery 2002 August;43(4):437-40

language: English

Effect of a human urinary protease inhibitor (Ulinastatin) on respiratory function in pediatric patients undergoing cardiopulmonary bypass

Sugita T. 1, Watarida S. 2, Katsuyama K. 2, Nakajima Y. 2, Yamamoto R. 2, Mori A. 2

1 Depart­ment of Car­di­o­vas­cular Sur­gery, Tenri Hos­pital, ­Tenri, ­Japan
2 Second Depart­ment of Sur­gery, Shiga Uni­ver­sity of Med­ical Sci­ence, ­Otsu, ­Japan


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Back­ground. We per­formed ­this pros­pec­tive ran­dom­ized ­study to deter­mine the ­effect of a ­human uri­nary pro­tease inhib­itor (Uli­nas­tatin) on res­pir­a­tory func­tion in pedi­atric ­patients under­going car­di­o­pul­mo­nary ­bypass.
­Methods. ­Twenty-two chil­dren ­were ­included in ­this ­study. ­They ­were ran­domly allo­cated to 1 of the fol­lowing ­groups; a con­trol ­group (n=11) or a Uli­nas­tatin ­group (n=11) in ­which ­patients ­received 5000 U/kg of Uli­nas­tatin. Arte­rial ­blood sam­ples ­were ­obtained ­before cardiopulmonary bypass (CPB), imme­di­ately ­after CPB, and 30 min­ ­after pro­ta­mine admin­is­tra­tion, as ­well as 3 ­hours ­after and 18 ­hours ­after CPB, and Inter­leukin-8 and neu­trophil elas­tase con­cen­tra­tion ­were eval­u­ated.
­Results. CPB ­time and ­aortic ­clamp ­time did not ­differ ­between the ­groups. Inter­leukin 8 and neu­trophil elas­tase con­cen­tra­tions ­before CPB ­increased sig­nif­i­cantly imme­di­ately ­after CPB, ­these con­cen­tra­tions did not ­differ ­between the ­groups. How­ever, neu­trophil elas­tase con­cen­tra­tions of a Uli­nas­tatin ­group ­were sig­nif­i­cantly lower ­than ­that of a con­trol ­group at 30 min after pro­ta­mine admin­is­tra­tion (a Uli­nas­tatin ­group: 1011.3±539.1 μg/ml, a con­trol ­group: 1619.7±595.7 μg/ml, p<0.05) and A-aDO2 of a Uli­nas­tatin ­group was sig­nif­i­cantly ­lower ­than ­that of a con­trol ­group at 2 ­hours ­after CPB (a Uli­nas­tatin ­group: 67.1±70.6 ­mmHg, a con­trol ­group: 169.2±116.3 g, p<0.05).
Con­clu­sions. ­These ­results sug­gest ­that Uli­nas­tatin sup­presses the ­increase in neu­trophil elas­tase and pro­tects the res­pir­a­tory func­tion in pedi­atric ­patients under­going car­di­o­pul­mo­nary ­bypass.

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