title: Effects of high-dose ulinastatin on inflammatory response and pulmonary function in patients with type-A aortic dissection after cardiopulmonary bypass under deep hypothermic circulatory arrest.
abstract: OBJECTIVE
  To investigate effects of high-dose ulinastatin on the release of proinflammatory cytokines and lung injury in patients with aortic dissection after cardiopulmonary bypass (CPB) under deep hypothermic circulatory arrest (DHCA).
  
  
  METHODS
  A prospective, randomized and double-blinded study.
  
  
  METHODS
  A teaching hospital.
  
  
  METHODS
  Thirty-six patients with acute type-A aortic dissection undergoing cardiac surgery using CPB under DHCA.
  
  
  METHODS
  These patients randomly were selected to received total doses of 20,000 units/kg of ulinastatin (n = 18) or 0.9% saline (control, n = 18) at 3 time points (after anesthetic induction, before aortic cross-clamp, and after aortic cross-clamp release).
  
  
  RESULTS
  Tumor necrosis factor-alpha, interleukin 6, interleukin 8 and polymorphonuclear neutrophil elastase (PMNE) were measured after anesthetic induction (T0), 30 minutes (T1) after aortic cross-clamp, 3 (T2), 6 (T3) and 9 (T4) hours after weaning from CPB. Except for T1, pulmonary data, such as alveolar-arterial oxygen pressure difference, physiologic deadspace, peak inspiratory pressure, plateau pressure, static compliance and dynamic compliance, were obtained at the same time points. Concentrations of cytokines and PMNE were significantly lower in the ulinastatin group than the control group from T1 to T4, and peaked at T2 between the 2 groups. Compared with the pulmonary data of the control group at T2~T4, postoperative alveolar-arterial oxygen pressure difference, physiologic deadspace, peak inspiratory pressure, and plateau pressure significantly were lower, and static compliance and dynamic compliance higher in the ulinastatin group. Significantly shorter intubation time and intensive care unit stay were found in the ulinastatin group.
  
  
  CONCLUSIONS
  High-dose ulinastatin attenuates the elevation of cytokines and PMNE, reduces the pulmonary injury and improves the pulmonary function after CPB under DHCA. Consequently, it shortens the time of intubation and intensive care unit stay.
authors.affiliation: Department of Cardiac Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, PR China.
authors.forename: Chong-En
authors.initials: CE
authors.lastname: Xu
authors.forename: Cheng-Wei
authors.initials: CW
authors.lastname: Zou
authors.forename: Meng-Yuan
authors.initials: MY
authors.lastname: Zhang
authors.forename: Ling
authors.initials: L
authors.lastname: Guo
mesh_terms: D000758:Anesthesia / Q000379:methods; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D050792:Circulatory Arrest, Deep Hypothermia Induced; D003250:Constriction; D016207:Cytokines / Q000097:blood; D005260:Female; D006023:Glycoproteins / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007249:Inflammation / Q000517:prevention & control*; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D019272:Leukocyte Elastase / Q000097:blood; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011182:Postoperative Care; D012129:Respiratory Function Tests; D056346:Sternotomy; D014361:Trypsin Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D016207:Cytokines; D006023:Glycoproteins; D015850:Interleukin-6; D016209:Interleukin-8; D014361:Trypsin Inhibitors; D014409:Tumor Necrosis Factor-alpha; D019272:Leukocyte Elastase; C028665:urinastatin