乌司他丁对肝移植患者呼出气冷凝液中炎症因子和肺功能的影响  

Effects of ulinastatin on inflammatory factors and lung function in exhaled condensate of liver transplant patients

作　　者：蔡俊刚 魏昌伟 罗婷[2] 吴安石[2] Cai Jungang;Wei Changwei;Luo Ting;Wu Anshi(Department of Anesthesiology,Peking University International Hospital,Beijing 102206,China;Department of Anesthesiology,Capital Medical University Affiliated Beijing Chaoyang Hospital,Beijing 100020,China)

机构地区：[1]北京大学国际医院麻醉科,102206 [2]首都医科大学附属北京朝阳医院麻醉科,100020

出　　处：《国际麻醉学与复苏杂志》2020年第9期855-860,共6页International Journal of Anesthesiology and Resuscitation

基　　金：天普研究基金(UF201411)。

摘　　要：目的分析乌司他丁对肝移植患者呼出气冷凝液中炎症因子和肺功能的影响。方法选取2016年4月至2017年4月在北京朝阳医院进行原位肝移植(orthotopic liver transplantation,OLT)手术的患者50例,按照随机数字表法分为两组(每组25例):乌司他丁组(U组)与生理盐水对照组(N组)。U组将乌司他丁10 kU/kg用生理盐水稀释至100 ml,在切皮前开始进行持续静脉输注,N组用等容量生理盐水代替。分别于用药前10 min(T1)、阻断肝血流前10 min(T2)、阻断肝血流后30 min(T3)、开放肝血流后30 min(T4)及手术结束前10 min(T5)抽取桡动脉血行血气分析,同时抽取肺动脉血;分别于用药前20 min(ET1)、阻断肝血流前20 min(ET2)、阻断肝血流后20 min(ET3)、开放肝血流后20 min(ET4)、手术结束前20 min(ET5)收集呼出气冷凝液(exhaled breath condensate,EBC),收集时长20 min。检测两组患者上述时点EBC与肺动脉血血清中TNF‑α、IL‑8、IL‑10及中性粒细胞弹性蛋白酶(neutrophil elastase,NE)水平,并记录T1~T5时点的气道峰压(peak airway pressure,Ppeak)、肺动态顺应性(pulmonary dynamic compliance,Cdyn)、PaO2、肺泡气‑动脉血氧分压差[alveolar‑arterial oxygen difference,P(A‑a)O2]、氧合指数(oxygenation index,OI)、呼吸指数(respiratory index,RI)等呼吸力学和肺功能指标,以及术后3 d内肺部并发症情况。结果两组患者各时点Ppeak、Cdyn差异无统计学意义(P>0.05)。T4时U组RI低于N组,OI高于N组(P<0.05);与T1时比较,N组在T4、T5时OI降低(P<0.05)。两组患者各时点EBC和血清中NE水平比较无统计学差异(P>0.05)。与ET1时比较,两组患者ET4、ET5时EBC中TNF‑α水平降低(P<0.05);U组ET5时EBC中TNF‑α水平低于N组(P<0.05)。与T1时比较,U组T4、T5时血清中TNF‑α水平降低(P<0.05);U组T4、T5时血清中TNF‑α水平低于N组(P<0.05)。与ET1时比较,N组ET5时,U组ET3、ET4、ET5时EBC中IL‑8水平降低(P<0.05);U组ET4、ET5时EBC中IL‑8水平低于Objective To analyze the effect of ulinastatin on inflammatory factors and lung function in exhaled breath condensate(EBC) of liver transplantation patients. Methods From April 2016 to April 2017, 50 cases of orthotopic liver transplantation(OLT) patients in Beijing Chaoyang Hospital were divided into two groups (25 cases in each group) using random number table method:ulinastatin group (group U) and saline control group (group N). Ulinastatin 10 kU/kg was diluted into 100 ml normal saline and continuousintravenous infusion was started before skin incision in group U, while equal volume normal saline was used in group N. The bloodsamples of radial artery and pulmonary artery were collected for blood gas analysis at 10 min before medication (T1), 10 min before hepatic blood flow occlusion (T2), 30 min after blocking hepatic blood flow (T3), 30 min after opening hepatic blood flow (T4) and 10 minbefore the end of operation (T5). EBC was collected at 20 min before treatment (ET1), 20 min before blocking hepatic blood flow (ET2),20 min after blocking hepatic blood flow (ET3), 20 min after opening hepatic blood flow (ET4) and 20 min before the end of operation(ET5), the length of EBC collection was 20 min. The levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-8, IL-10 and neutrophilelastase (NE) in EBC and serum at the above time points were detected, and the peak airway pressure (Ppeak), pulmonary dynamic compliance(Cdyn), arterial partial pressure (PaO2), alveolar-arterial oxygen difference [P(A-a)O2], oxygenation index (OI), respiratory index(RI) and other respiratory mechanics and pulmonary function indexes at T1‒T5 were recorded. Pulmonary complications within 3days after operation were also recorded. Results There was no significant difference in Ppeak and Cdyn between the two groups (P>0.05). RI in group U was lower than that in group N at T4 (P<0.05), OI in group U was higher than that in group N at T4 (P<0.05). OI ingroup N was lower at T4 and T5 compared with T1 (P<0.05). Level of NE: There was

关 键 词：肝移植 乌司他丁 呼出气冷凝液 炎症因子 肺功能 

分 类 号：R657.3[医药卫生—外科学]