乌司他丁对肝移植术后肺血管通透性的影响  

Influence of ulinastatin on lung permeability after liver transplantation

作　　者：方明星[1] 刘娜[2] 郭建英[1] 张华伟[1] 李燕[1] 张丽霞[1] 吴春涛[1] 黄庆生[1] 董士民[3] 王智勇[1] 

机构地区：[1]河北医科大学第三医院ICU,河北石家庄050017 [2]河北医科大学第四医院急诊科,河北石家庄050011 [3]河北医科大学第三医院急诊科,河北石家庄050017

出　　处：《临床荟萃》2015年第7期814-817,共4页Clinical Focus

基　　金：河北省卫生厅青年科技课题(20120343)

摘　　要：目的探讨乌司他丁对肝移植术后肺血管通透性的改善作用。方法选取肝移植术后患者36例随机分为两组,常规组接受常规性治疗,乌司他丁组在常规治疗基础上应用乌司他丁(60万U,每日1次,静脉滴注)。监测两组患者肺血管通透性:超声肺水B线评分、血管外肺水(EVLWI)、肺血管通透性指数(PVPI)、氧合指数(PO2/FiO2)、肺泡与肺动脉氧分压差[PO2(A-a)]及内皮素1(ET-1);脉搏指示性连续性心排量监测(PICCO)血流动力学参数;脱离呼吸机时间以及观察期间液体累计出入量等。结果与常规组比较,乌司他丁组脱离呼吸机时间明显缩短、超声肺水B线评分、EVLWI、PVPI和PO2(A-a)下降;PO2/FiO2上升(P<0.05)。PICCO血流动力学参数比较差异无统计学意义(P>0.05)。结论肝移植术后应用乌司他丁有利于改善肺脏血管通透性,缩短机械通气时间。Objective To explore the effect of ulinastatin on lung permeability.Methods A prospective,randomized and controlled study was carried out in 36 patients after liver transplantation.All 36 patients were randomly divided into two groups,including patients with routine treatment and patients with routine treatment combined ulinastin（600 000 unit per day,3days）.Lung permeability（index of ultrasound B line indicating lung water,extravascular lung water index,PO2/FiO2,PO2（A-a）,and endothelin-1）,hemodynamic values（central venous pressure and PICCO）,time of weaning ventilation,and volume of input-output fluid were detected in two groups.Results Compared with routine treatment group,the time of weaning ventilation of ulinastin group was significantly reduced（P〈0.05）.The values of lung permeability of B group,extravascular lung water index,PVPI and PO2（A-a）were significantly decreased in ulinastin group than in routine treatment group（all P〈0.05）.The value of PO2/FiO2 was significantly increased in ulinastin group than in routine treatment group（P〈0.05）.There were no significant difference in hemodynamic values between two groups（P〉 0.05）.Conclusion Ulinastatin can improve the lung permeability and reduce the time of mechanical ventilation after liver transplantation.

关 键 词：肝移植 毛细血管通透性 通气机 机械 乌司他丁 

分 类 号：R657.3[医药卫生—外科学]