乌司他丁对肝移植术患者凝血功能的影响  

Effect of ulinastatin on coagulation function in patients undergoing orthotopic liver transplantation

作　　者：冯国辉[1] 董兰[1] 雷志礼[1] 李军[2] 张宏[2] 

机构地区：[1]武警总医院麻醉科,北京市100039 [2]解放军总医院麻醉科

出　　处：《中华麻醉学杂志》2009年第4期296-298,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价乌司他丁对肝移植术患者凝血功能的影响。方法拟行原位肝移植术的终末期肝病患者20例，年龄36～59岁，ASAⅢ或Ⅳ级，随机分为2组：对照组（C组）和乌司他丁组（U组）。U组切皮后静脉输注乌司他丁2万U／min，持续1h，乌司他丁输注量120万U（加入400ml生理盐水中），每隔4h重复输注；C组给予等容量生理盐水。分别于麻醉后切皮前、无肝前期30min、无肝期30min、新肝期30min和术毕时采集中心静脉血样，测定Sonoclot凝血功能指标、常规凝血功能指标及血浆Ca^2＋浓度，记录术中出血量、输血量及术后24h引流量。结果与麻醉后切皮前比较，两组凝血酶时间、凝血酶原时间、活化部分凝血活酶时间、激活凝固时间延长，纤维蛋白原浓度、Ca^2＋浓度、纤维蛋白凝集率和血小板功能降低，C组D-二聚体浓度升高（P〈0．05）；与c组比较，U组D-二聚体浓度降低，血小板功能增强，术后24h引流量降低（P〈0．05），其余指标差异无统计学意义（P〉0．05）。结论术中静脉输注乌司他丁可改善肝移植术患者凝血功能，减少术后出血。Objective To evaluate the effect of ulinastatin on coagulation function in patients undergoing orthotopic liver transplantation （OLT）. Methods Twenty ASA Ⅲ or Ⅳ patients with end-stage liver diseases undergoing OLT, aged 36-59 yr, were randomly divided into 2 groups （ n = 10 each） ： control group （group C） and ulinastatin group （group U） . Group U received iv infusion of ulinastatin 2 × 10^4 U/min for 1 h （ulinastatin 12 × 10^5 U in 400 ml normal saline） after skin incision and repeated every 4 h. Group C received the same volume of normal saline instead of ulinastatin. Anesthesia was induced with midazolam 0.05-0.1 mg/kg, etomidate 0.3 mg/kg, fentanyl 5 μg/kg, and vecuronium 0.1 mg/kg and maintained with isoflurane inhalation （end-tidal concentration 0.3%-0.6% ） and intermittent iv boluses of fentanyl 2-3 μg/kg and vecuronium 0.5 mg/kg and iv infusion propofol at 2-4 mg· kg^-1· h^-1 . Blood samples were taken before skin incision, 30 min of preanhepatic phase, 30 min of anhepatic phase, 30 rain of neohepatic phase for determination of Sonoclot and routine coagulation function and plasma Ca^2＋ concentration. Blood loss and transfusion volume during operation, and 24-h drainage flow after operation were recorded. Results Compared with the values before skin incision, thrombin time, prothrombin time, activated partial thromboplastin time, activated clotting time were prolonged, and concentrations of fibrinogen and plasma Ca^2＋ , fibrinogen clotting rate and platelet tunction decreased in both groups, anti D-dimer concentration was significantly increased in group C （ P 〈 0.05）. D-dimer conccntration was significantly lower, platelet function higher and 24-h drainage flow after operation lower in group U than in group C （ P 〈 0.05）, but there were no, significant differences in the other indices between group U anti C （ P 〉 0.05）. Conclusion Intravenous infusion of ulinastatin during operation can improve coagulation function and reduce postoperative blond lo

关 键 词：胰蛋白酶抑制剂 肝移植 血液凝固试验 

分 类 号：R614[医药卫生—麻醉学]