Effects of Ulinastatin on Inflammatory Response to Cardiopulmonary Bypass in Cardiac Valve Replacement Surgery

OBJECTIVE:To evalute the effect of ulinastatin on the changes of inflammatory cytokines and inflammatory response resulting from cardiopulmonary bypass(CPB)in cardiac valve replacement surgery.METHODS:Thirty-six patients scheduled for elective cardiac valve replacement with CPB were randomly divided into two groups of 18 each:control group(C)and ulinastatin group(U).Group U received ulinastatin 1.2×104 U/kg and group C received same volume of normal saline instead of ulinastatin as control.Blood samples were taken from radial artery for determination of plasma TNF-α,IL-6 and IL-10 concentrations before induction of anesthesia(T1),1 h after start of CPB(T2),1 h after(T3)and 24 h(T4)after termination of CPB.All of these was estimated by enzyme-linked immunosorbent assay(ELISA).RESULTS:There was no signif icant difference between two groups in plasma TNF-α,IL-6 and IL-10 level at T1.The level of TNF-α,IL-6 and IL-10 was significantly increased at T2-T4 compared with that before CPB(T1)in both groups.However,the plasma concentrations of TNF-αand IL-6 were significantly lower while the level of IL-10 was significantly higher in group U than those in group C at T2-T4.CONCLUSION: Ulinastatin could reduce the increased amplitude of plasma levels of TNF-αand IL-6,whereas enhance the increased amplitude of the plasma IL-10 levels that result from CPB in cardiac valve replacement.In other word,Ulinastatin posseses the effect to regulate inflammatory cytokines balance and down-regulate inflammatory response during CPB.