乌司他丁对原位肝移植手术患者血浆心肌肌钙蛋白I的影响  

Effects of ulinastatin on plasma cardiac troponin I in patients undergoing orthotopic liver transplantation

作　　者：宋志冰[1,2] 赵林林[3] 王韬甫[4] 刘功俭[3] 刘苏[3] 

机构地区：[1]徐州医学院,221002 [2]河南省胸科医院 [3]徐州医学院附属医院麻醉科 [4]河南省胸科医院麻醉科

出　　处：《临床麻醉学杂志》2015年第1期29-32,共4页Journal of Clinical Anesthesiology

摘　　要：目的观察不同剂量乌司他丁对原位肝移植手术患者血浆心肌肌钙蛋白I（cTnI）浓度的影响。方法选择45例行原位肝移植术的重度肝硬化患者,ASAⅢ或Ⅳ级,随机均分为三组：乌司他丁1组（U1组）、乌司他丁2组（U2组）和对照组（C组）,于手术开始分别静脉输注乌司他丁0.5×10^4、1.0×10^4 U/kg及等容量生理盐水,每4小时重复给药,直至手术完毕。于切皮前即刻、无肝期5、30min、新肝期5、30min、术毕即刻记录HR、MAP、CVP、MPAP、PAWP和CO,于切皮前即刻（T0）、无肝期30min（T1）、新肝期30min（T2）、术毕即刻（T3）、术后4h（T4）及术后24h（T5）采集中心静脉血采用i-STAT cTnI测试卡测定血浆cTnI浓度;记录术后24h心律失常（频发室早、室颤、房颤、Ⅱ度以上的房室传导阻滞等）、心肌梗死发生情况和死亡率。结果与切皮前即刻比较,三组无肝期5、30min、新肝期5、30 min和术毕即刻HR明显增快（P〈0.05）,无肝期5、30 min CVP、MPAP、PCWP和无肝期5、30min、新肝期5、30min CO明显降低（P〈0.05）,而新肝期5min CVP明显升高（P〈0.05）。三组间患者的血流动力学指标差异均无统计学意义。与T0时比较,T2～T5时三组患者血浆cTnI浓度明显升高（P〈0.01）。与C组比较,T2～T5时U1组和U2组血浆cTnI浓度明显降低（P〈0.05）。与U1组比较,T3～T5时U2组血浆cTnI浓度明显降低（P〈0.01）。术后24h三组患者心律失常发生率差异无统计学意义,无一例患者发生心肌梗死和死亡。结论乌司他丁可降低原位肝移植手术患者血浆cTnI浓度,其降低程度与剂量相关。Objective To investigate the effects of different doses of ulinastatin on plasma cardiac troponin I（cTnI） in patients undergoing orthotopic liver transplantation（OLT）.Methods Forty-five ASA Ⅲ orⅣ patients with severe hepatic cirrhosis underwent OLT were randomly divided into three groups（n=15）：ulinastatin group 1,ulinastatin group 2（group U1,U2）and control group（group C）.In ulinastatin groups,ulinastatin was infused intravenously at the beginning of operation：group U1,0.5×10^4 U/kg;group U2,1.0×10^4 U/kg.The same volume of normal saline was given to the control group.The ulinastatin or saline were given every four hours until the end of operation.HR,MAP,CVP,MPAP,PAWP and CO were recorded at 5and 30 min of anhepatic phase,5and 30 min of neohepatic phase,the end of operation,4hand 24 hafter the surgery.Blood samples were collected from the central vein for assessing the concentrations of cTnI right before the skin incision（T0）,30 min of anhepatic phase（T1）,30 min of neohepatic phase（T2）,the end of operation（T3）,and 4h（T4）and 24h（T5）after the surgery.The incidence of arrhythmia,myocardial infarction and the mortality within 24 hours after surgery were also recorded.Results Compared with T0 in three group,HR was increased significantly at 5and 30 min of anhepatic phase,5and 30 min of neohepatic phase,the end of operation（P〈0.05）.CVP,MPAP,PAWP were decreased significantly at 5and 30 min of anhepatic phase（P〈0.05）.CO was decreased significantly at 5and 30 min of anhepatic phase,5and 30 min of neohepatic phase（P〈0.05）.CVP was increased significantly at 5min of anhepatic phase（P〈0.05）.There were no significant hemodynamic differences between the three groups.The plasma cTnI concentration in three groups at T2-T5 was increased significantly（P〈0.01）when compared with that at T0.At T2-T5,the plasma cTnI concentration of two experimental groups were lower（P 0.05）when compared with group C.At T3-T5,the concentration of cTnI in group U2 was

关 键 词：肝移植 乌司他丁 心肌肌钙蛋白I 

分 类 号：R657.3[医药卫生—外科学]