[Usefulness of ulinastatin as a radical scavenger for protection of reperfusion injury after myocardial ischemia in open heart surgery].

The usefulness of ulinastatin for protection of reperfusion injury after myocardial ischemia was evaluated in 25 patients undergone open heart surgery (18 cases with coronary artery bypass grafting and 7 with valve replacements). Twenty five patients were divided into two groups; U (+)-group consisted of 12 patients with ulinastatin (10,000 IU/kg) injected via the aortic root just before aortic declamping, and U (-)-group of 13 patients without ulinastatin. There were no significant differences between the two groups in age, body weight, total cardiopulmonary bypass (CPB) time, and aortic cross clamp time. Blood samples were obtained from coronary sinus before the start of CPB, just before the aortic cross clamp and immediately after reperfusion, and 1 and 3 hours later. Levels of thiobarbituric acid (TBA), alpha-tocopherol (alpha TOC), polymorphonuclear elastase (PMNE), creatine phosphokinase (CK) and creatine phosphokinase isoenzyme (CK-WB) release were measured, and myocardial aerobic metabolism was also evaluated. At each time point after reperfusion, TBA levels in U (+)-group were significantly less (p less than 0.05), and alpha TOC levels were significantly higher (p less than 0.05) than those in U (-)-group. PMNE increased progressively during CPB and showed a peak at 3 hours after reperfusion. And both groups showed increased lactate production and anaerobic metabolism immediately after reperfusion and 1 hour later, as evidenced by changes in excess lactate and redox potential of lactate and pyruvate. There was, however, no significant difference between the two groups with CK-MB as well as CK release.(ABSTRACT TRUNCATED AT 250 WORDS)