乌司他丁对原位肝移植术患者围术期肾功能的影响  

Effects of ulinastatin on perioperative renal function in patients undergoing orthotopic liver transplantation

作　　者：冯国辉[1] 雷志礼[1] 宇鹏[1] 宁新宇[1] 韦中余[2] 李军[3] 刘多辉[1] 董兰[1] 韩暑君 李会光[1] 

机构地区：[1]北京武警总医院麻醉科,100039 [2]北京武警总医院 院ICU,100039 [3]海军总医院麻醉科

出　　处：《中华麻醉学杂志》2005年第11期853-855,共3页Chinese Journal of Anesthesiology

摘　　要：目的乌司他丁对原位肝移植术患者围术期肾功能的影响。方法 40例择期行原位肝移植术患者,随机分为2组,乌司他丁组(U组,n=20):切皮后将乌司他丁30万IU加入100 ml生理盐水,持续静脉输注1 h,之后每4小时重复一次直至术后48 h。对照组(C组,n=20):以等容量生理盐水代替。测定麻醉前、术毕、术后24、48 h血清尿素氮(BUN)、肌酐(Cr)的水平及尿N-乙酰β-D氨基葡萄糖苷酶(NAG)、视黄醇结合蛋白(RBP)、α1-微球蛋白(α1-MG)、γ-谷氨酰转肽酶(γ-GTP)的水平。结果麻醉前组间血清BUN、Cr及尿γ-GTP、RBP、α1-MG、NAG水平差异均无统计学意义(P>0．05)。与麻醉前比较,C组血清BUN和Cr在术后24、48 h升高(P<0．05或0．01),尿γ-GTP、α1-MG、RBP和 NAG在各时点升高(P<0．01);U组血清BUN、Cr和尿γ-GTP、NAG在各时点差异无统计学意义(P> 0．05),尿α1-MG在各时点升高(P<0．01),尿RBP在术后24、48 h升高(P<0．05或0．01)。与C组比较,U组血清BUN、Cr和尿α1-MG在术后24、48 h降低,尿γ-GTP、RBP和NAG在各时点降低(P<0．05 或0．01)。结论乌司他丁对原位肝移植术患者围术期肾功能有一定的保护作用。Objective To investigate the effects of ulinastatin on perioperative renal function in patients undergoing orthotopic liver transplantation （OLT）. Methods 40 patients receiving OTL were divided randomly into control group （group C, n = 20） and ulinastatin group （group U, n = 20）. Ulinastatin group received intravenous infusion of ulinastatin 3 × 10^5 IU in 100 ml normal saline over 1 hour after skin incision, subsequently repeated every four hours up to 48 h after operation. Control group received same amount of normal saline instead of ulinastatin. Venous boold samples were taken before anesthesia （baseline）, at the end of surgery （T1） and at 24 and 48h after operation （T2-3） for determination of serum nitrogen （BUN）, and creatinine （Cr） concentrations. Urine specimens were taken for determination the levels of N-acetyl-beta-D-glucosaminidase （NAG）, γ- glutamyltranspeptidase （γ-GTP）, α1-microglobulin （α1-MG）, and retinal binding protein （RBP） at T1-3 respectively. Results Before anesthesia there were no significant differences in all the parameters above between two groups （ P 〉 0.05）. Compared with the baseline values（T1 ）, serum BUN and Cr concentrations at T2,3, and urine levels of γ-GTP, α1-MG, RBP and NAG at T1-3 significantly increased in group C; in group U urine α1-MG level at T1-3 and RBP level at T2,3 significantly increased（ P 〈 0.01 or 0.05）, serum concentrations of BUN and Cr, urine levels of γ-GTP and NAG unchanged significantly （ P 〉 0.05）. Serum levels of BUN and Cr, urine α1 -MG level at T2,3, urine levels of γ-GTP, RBP and NAG at T1-3 were significantly lower in group U than in group C （ P 〈 0.01 or 0.05）. Conclusion Ulinastatin can protect perioperative renal function to some degree in patients undergoing OLT.

关 键 词：胰蛋白酶抑制剂 肝移植 肾功能试验 

分 类 号：R614[医药卫生—麻醉学] R657.3[医药卫生—外科学]