乌司他丁对膝关节置换术后肝功能的影响  

Effect of Ulinastatin on Liver Function of Patients after Bilateral Total Knee Arthroplasty

作　　者：唐帅[1] 徐仲煌[1] 刘硕[1] 杨宏[2] 任丽英[1] 钱文伟[3] 黄宇光[1] 

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院麻醉科,北京100730 [2]安徽省淮北市人民医院麻醉科,安徽淮北235000 [3]中国医学科学院,北京协和医学院,北京协和医院骨科,北京100730

出　　处：《中国医学科学院学报》2014年第5期526-529,共4页Acta Academiae Medicinae Sinicae

摘　　要：目的观察乌司他丁对接受充气式止血带下双侧全膝关节置换术(TKA)患者术后肝功能的影响。方法选择拟在大腿止血带下接受双侧TKA的患者40例,随机分为试验组和对照组,分别通过静脉给予乌司他丁和生理盐水。所有患者均采用相同的全身麻醉和术后镇痛方案,分别于术前,术后4、24、48、72 h抽取上肢静脉血检测丙氨酸氨基转移酶(ALT)、总胆红素(TBil)、直接胆红素(DBil)水平。结果两组患者术前各项肝功能指标差异均无统计学意义(P均>0.05)。与术前相比,对照组ALT术后没有显著变化(P均>0.05),试验组在术后48(P=0.002)、72 h(P=0.001)均显著降低;对照组TBil和DBil在术后48(P=0.012,P=0.000)、72 h(P=0.000,P=0.000)均显著升高,而试验组仅在术后48 h显著升高(P=0.010,P=0.038)。试验组ALT在术后4(P=0.026)、48(P=0.013)、72 h(P=0.004)均显著低于对照组,TBil在术后72 h显著低于对照组(P=0.036);两组各时间点的DBil差异均无统计学意义(P均>0.05)。结论在双侧TKA术前和术中应用乌司他丁具有肝脏保护作用。Objective To investigate the effect of ulinastatin, a urinary trypsin inhibitor, on the post- operative liver function in patients who have received bilateral total knee arthroplasty （TKA） under pneumatic tourniquet. Methods Totally 40 patients who were scheduled to receive bilateral TKA under thigh tourniquet were randomly assigned into trial group （U group, receiving intravenous ulinastatin ） and control group （C group, receiving natural saline）. All patients received the same general anesthesia and postoperative analgesia. The plasma concentrations of alanine transaminase （ALT）, total bilirubin （TBil）, and direct bilirubin （DBil） were recorded and compared preoperatively and 4, 24, 48, and 72 hours after the surgery. Results The demographic data were not significantly different between these two groups （P 〉 0.05 ） . The ALT was not significantly changed after the surgery in the C group （P 〉 0.05 ） but was significantly decreased 48 hours （P =0. 002 ） and 72 hours （P = 0. 001 ） after the surgery in the U group. TBil and DBil were significantly increased 48 hours （P =0. 012, P =0. 000） and 72 hours （P =0. 000, P =0. 000） after the surgery in C group, while only that at 48 hours （P = 0. 010, P = 0. 038） was significantly increased in the U group. ALT 4 hours （ P = 0. 026）, 48 hours （P = 0. 013 ）, 72 hours （ P = 0. 004） after the surgery were significantly lower in the U group than those in C group. TBil at the 72 hours postoperatively in U group was significantly lower than that in C group （P =0. 036）. DBil was not significantly different between C group and U group at all time points （all P 〉 0. 05 ） . Conclusion The application of ulinastatin in bilateral TKA can protect postoperative liver function.

关 键 词：全膝关节置换术 乌司他丁 充气式止血带 肝功能 

分 类 号：R614.2[医药卫生—麻醉学]