心・大血管手術の臓器に及ぼす影響と臓器不全の予防—ulinastatin使用群と非使用群の比較

The effect of open heart surgery and an operation on thracic aneurysm on organs and the prevention of an organ system failure:Comparison between the group using ulinastatin and the group not using ulinastatin

　心・大血管手術の予後を決めるうえで，臓器不全の合併は重要である^1,2）。そのなかでも呼吸不全は特に重要と考えられる^2）。また，いったん臓器不全に陥ると術後でなくても死亡率は高く，3個以上の多臓器不全を併発すると死亡率は非常に高率となる^3）。そこで，臓器不全が進行する前に，適切な治療を行うことが必要となってくる。

　ウリナスタチン（以下US）には，ショック後の急性臓器不全の改善^4），心筋抑制因子（MDF）の産生抑制^5），開心術後の末梢における酸素利用の改善^6）等が認められている。心・大血管手術後にUSを用いることによって，臓器不全を予防あるいは改善できる可能性があるかどうか調べた。また，心・大血管手術が，腎機能，肝機能，呼吸機能，凝固線溶系にどういった影響を及ぼすかを検討するとともに，特に呼吸不全に対するUS使用の効果を検討した。

We studied the effect of the open heart surgery and the thoracic aortic aneurysm surgery on renal, liver and respiratory function and the coagulo-fibrinolytic system. We also investigated as to whether ulinastatin was effective or not with regard to preventing an organ system failure.

The renal fuction, liver function and the coagulo-fibrinolytic system were preserved, although there was a greater number of severe cases in the group which used ulinastatin (US group) than in the group that did not use ulinastatin (non-US group).

In the US group, Pa0₂ did not decrease post-operatively. However, in the non-US group, Pa0₂ decreased significantly after the operation. The variables in relation to using ulinastatin, examined by a stepwise method, included kind of desease, emergency operation, PaO₂, BUN and serum pla-sminogen. The multiple coefficient for these five variables was 0.623 (p<0.01) and the contribution was 38.8%.

It was suggested that ulinastatin could prevent an organ system failure, especially respiratory fai-lure, after open heart surgery and the thoracic aortic aneurysm surgery.