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[Protective effects of high-dose ulinastatin on vital organs in patients receiving total arch replacement for type A
Xian-Yue Wang1, Wen-Peng Dong, Guang Tong
1Department of Cardiovascular Surgery, the Military General Hospital of Guangzhou Command(affiliated hospital of the Second military medical university), Guangzhou, China 510010.
Insights
High-dose ulinastatin may protect pulmonary function and reduce brain injury markers in patients undergoing type A aortic dissection surgery. However, its specific protective effects on the brain require further investigation.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Pharmacology
Background:
- Type A aortic dissection is a life-threatening condition requiring complex surgical repair.
- Total arch replacement is a critical procedure with potential for organ injury.
- Ulinastatin is a protease inhibitor with potential organ-protective properties.
Purpose of the Study:
- To evaluate the efficacy of high-dose ulinastatin in protecting vital organs during total arch replacement for type A aortic dissection.
- To assess the impact of ulinastatin on postoperative organ function and complications.
Main Methods:
- A prospective study involving 66 patients with type A aortic dissection undergoing total arch replacement.
- Patients were divided into two groups: ulinastatin treatment (300,000 U/8h and during cardiopulmonary bypass) and control.
- Comparison of surgical data, biochemical profiles, and postoperative outcomes including ICU stay, complications, and mortality.
Main Results:
- Ulinastatin group showed lower lactate, S-100, and neuron-specific enolase levels postoperatively.
- Patients receiving ulinastatin had a shorter ICU stay and reduced incidence of pulmonary infections and prolonged ventilation.
- No significant differences were observed in renal or liver function, re-operation rates, or neurological complications.
Conclusions:
- High-dose ulinastatin demonstrates protective effects on pulmonary function in patients undergoing total arch replacement for type A aortic dissection.
- Ulinastatin may reduce specific markers of brain injury, but its overall neuroprotective role warrants further study.
- The treatment did not significantly impact renal function, liver function, or bleeding complications.
Objective:
To investigate the protective effects of high-dose ulinastatin on the vital organs in patients undergoing total arch replacement for type A aortic dissection.
Methods:
Between September 2014 and March 2016, 66 patients with type A aortic dissection underwent total arch replacement at our center. Thirty-six of the patients received ulinastatin treatment at 300 000 U/8 h from admission to 3 days postoperatively and at 300 000 U/2 h during cardiopulmonary bypass surgery (UTI group), and the other 30 patients did not receive perioperative ulinastatin treatment (control group). The surgical data and blood biochemistry profiles on days 1, 3, and 5 postoperatively were compared between the two groups, and the postoperative ICU stay, re-operation for bleeding, ventilation for over 7 days, ultrafiltration for postoperative renal failure, tracheotomy, incidences of pulmonary and neurological complications and hospital death were also compared.
Results:
s The operating time, cardiopulmonary bypass time, ACP time, cardiac arrest time, the lowest rectal temperature and frequency of bilateral and unilateral antegrade selective cerebral perfusion were similar between the two groups (P>0.05). Compared with those in the control group, patients in UTI group had lower lactate, S-100 and neuron specific enolase levels on the first postoperative day and higher OI on the 1st, 3rd, and 5th postoperative days (P<0.05), but serum creatinine, blood urea nitrogen, total bilirubin, and alanine aminotransferase levels were comparable between the two groups (P>0.05). No significant differences were found in the frequency of re-operation for bleeding, ultrafiltration for renal failure, tracheotomy, neurological complications or hospital death after the operation between the two groups, but the patients in UTI group had a shorter ICU time, a less frequent long-term ventilation and a lower incidence of pulmonary infection (P<0.05).
Conclusion:
High-dose ulinastatin offers protection on pulmonary function and lowers the specific brain injury markers in patients with type A aortic dissection after total arch replacement, but its protective effects on brain is uncertain.
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