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[Effects of ulinastatin on granulocyte elastase and fibronectin in patients undergoing cardiopulmonary bypass]
K Enzan1, H Mitsuhata, Y Masaki
1Department of Anesthesiology, Akita University School of Medicine.
Insights
Ulinastatin administration during cardiopulmonary bypass (CPB) helps maintain host defense function. Giving ulinastatin after anesthesia induction and during CPB reduces harmful increases in granulocyte elastase (GEL) and preserves fibronectin (FN) levels post-surgery.
Area of Science:
- Cardiology
- Biochemistry
- Immunology
Background:
- Cardiopulmonary bypass (CPB) can compromise host defense mechanisms.
- Increases in granulocyte elastase (GEL) and decreases in fibronectin (FN) are markers of this compromise.
Purpose of the Study:
- To investigate the effects of ulinastatin on GEL and FN levels following CPB.
- To determine optimal timing for ulinastatin administration to preserve host defense.
Main Methods:
- A study involving 30 patients undergoing CPB.
- Ulinastatin administered either post-anesthesia induction (U1) or during CPB (U2).
- Measured GEL and FN levels pre- and post-CPB, and on postoperative day 1.
Main Results:
- GEL levels increased significantly post-CPB, but were lower in the U2 group.
- FN levels showed variable changes, decreasing postoperatively across all groups.
- Correlations found between CPB time and GEL/FN changes in control and U1 groups.
Conclusions:
- Ulinastatin administration during CPB is beneficial for maintaining host defense.
- Administering ulinastatin both after anesthesia induction and during CPB is recommended for optimal outcomes.
Abstract:
We investigated the effects of ulinastatin on the increase of granulocyte elastase (GEL) and the decrease of fibronectin (FN) after cardiopulmonary bypass (CPB) in 30 patients undergoing cardiopulmonary bypass. Ulinastatin 300,000 units were given immediately after the induction of anesthesia (U1) or during CPB (U2). GEL increased by 20 times after CPB. GEL was lower in U2 than those in other groups. FN increased by 7-13% after CPB in U1 but decreased in other groups. FN decreased by 21-13% on the first postoperative day in three groups. There was a close relationship between CPB time and increase of GEL in the control group (no ulinastatin given) (y = 18.5 x -833, r = 0.751), between CPB time and increase of FN in U1 (y = 1.4 x -163.4, r = 0.683) or increases of GEL and FN in the control group (y = 0.068 x -202.6, r = 0.812). From these results, we recommend that ulinastatin should be given after the induction of anesthesia and during CPB, to keep a favorable host defense function after CPB.