Ulinastatin in combination with aprotinin improves systemic inflammation in patients undergoing cardiac surgery with cardiopulmonary bypass.

objectiveTo investigate the impact of ulinastatin combined with protease inhibitors on serum inflammatory factors in patients undergoing cardiac surgery with cardiopulmonary bypass.

methodsA retrospective analysis was conducted on 86 patients who underwent cardiac surgery with cardiopulmonary bypass at Xi'an Gaoxin Hospital from May 2019 to June 2021. Based on the administration of drugs by a micro-infusion pump after anesthesia induction and before skin incision, the patients were divided into an observation group (receiving ulinastatin at a dose of 12,000 U/kg and protease inhibitors at a dose of 4 million units) with 46 cases and a control group (receiving protease inhibitors at a dose of 2 million units) with 40 cases. Peripheral blood leukocyte count, neutrophil percentage, interleukin (IL)-6, tumor necrosis factor (TNF)-α, serum creatine kinase isoenzyme (CK-MB), and serum cardiac troponin I (cTnI) levels were measured and compared between the two groups before surgery, 1 hour after surgery, and 24 hours after surgery. The positive inotropic drug usage, duration of postoperative mechanical ventilation, and incidence of complications were also compared between the two groups. Finally, an analysis was conducted to identify independent risk factors affecting patient prognosis.

resultsThe peripheral blood white blood cell (WBC) count, neutrophil percentage, serum inflammatory factor level, CK-MB, and cTnI of the two groups of patients at 1 h and 24 h after the operation were significantly higher than those before the operation. However, the observation group had significantly lower levels of peripheral blood WBC count, neutrophil percentage, serum inflammatory factors, CK-MB, and cTnI compared to the control group (all P<0.05). Additionally, the observation group had significantly lower dopamine dosage and a shorter duration of mechanical ventilation compared to the control group (all P<0.05). The incidence of complications was lower in the observation group compared to the control group (P<0.05). TNF-α, cTnI, and treatment regimen were identified as independent risk factors associated with adverse patient prognosis.

conclusionThe perioperative use of ulinastatin combined with protease inhibitors in patients undergoing cardiac surgery with cardiopulmonary bypass is beneficial in suppressing systemic inflammatory response, improving cardiopulmonary function, and reducing the incidence of complications. These findings suggest its clinical utility.