乌司他丁对胰-肾联合移植患者围术期心肌损伤的影响  

Influence of uinastatin on perioperative myocardial injury in patients undergoing simultaneous pancreas-kidney transplantation

作　　者：芦树军[1] 张雅静[2] 喻文立[1] LU Shujun;ZHANG Yajing;YU Wenli(Department of Anesthesiology,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院麻醉科,300192 [2]天津中医药大学第一附属医院麻醉科

出　　处：《临床麻醉学杂志》2022年第5期453-457,共5页Journal of Clinical Anesthesiology

基　　金：天津医学会麻醉学分会中青年科研培育基金项目(TJMZJJ-2019-01)。

摘　　要：目的探讨乌司他丁对胰-肾联合移植围术期患者心肌损伤的影响,分析其可能的机制。方法选择2018年1月至2020年6月拟行胰-肾联合移植术患者80例,男43例,女37例,年龄18~64岁,BMI 20~25 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法将患者分为两组:对照组(C组)和乌司他丁组(U组),每组40例。U组于麻醉诱导后静脉输注乌司他丁300000 IU,之后每4小时重复输注,直至手术结束。C组于相同时点静脉输注等容量生理盐水。于麻醉诱导后5 min(T_(0))、肾动静脉开放前5 min(T_(1))、肾动静脉开放后30 min(T_(2))、胰腺相关动静脉开放后30 min(T_(3))、术毕即刻(T_(4))、术后4 h(T_(5))、24 h(T_(6))采集中心静脉血6 ml,检测血清TNF-α、IL-6、IL-18、心肌肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)浓度。记录T_(0)-T_(6)时ECG ST段及T波的变化,记录术中使用多巴胺维持循环灌注、高血压或低血压、心肌缺血和室性早搏的发生情况。结果与T_(0)时比较,T_(2)-T_(6)时两组血清TNF-α、IL-18、cTnI、CK-MB浓度明显升高(P<0.05),T_(2)-T_(5)时C组血清IL-6浓度明显升高(P<0.05),T_(3)时U组血清IL-6浓度明显升高(P<0.05)。与C组比较,U组T_(2)-T_(6)时血清TNF-α、cTnI、CK-MB浓度明显降低(P<0.05),T_(2)-T_(4)时血清IL-6浓度明显降低(P<0.05),T_(3)-T_(6)时血清IL-18浓度明显降低(P<0.05)。T_(2)时C组21例(52%)、U组17例(42%)ECG出现ST段压低或T波高尖;T_(3)时C组26例(65%)、U组19例(48%)ECG出现ST段压低或T波高尖。C组13例(32%)、U组9例(22%)术中使用多巴胺维持循环灌注,两组高血压或低血压、心肌缺血和室性早搏发生率差异均无统计学意义。结论乌司他丁可减轻胰-肾联合移植患者围术期心肌损伤,改善心功能,加速患者康复,其机制可能是通过减少胰-肾联合移植患者围术期炎性因子的释放。Objective To investigate the influence of ulinastatin on perioperative myocardial injury in patients undergoing simultaneous pancreas-kidney transplantation and to analyze its possible mechanism.Methods Eighty patients underwent simultaneous pancreas-kidney transplantation from January 2018 to June 2020,43 males and 37 females,aged 18-64 years,BMI 20-25 kg/m^(2),ASA physical statusⅡorⅢ,were selected into two groups by random number table method:control group(group C)and uselastatin group(group U),40 patients in each group.Group U administered ulinastatin 300000 IU after anesthesia induction and repeated every 4 hours until the end of the procedure,group C had equal timing for intravenous infusion of equal volume saline.6 ml of central venous blood was collected and serum concentrations of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and interleukin-18(IL-18),cardiac troponin I(cTnI),creatine kinase isoenzyme(CK-MB)and the changes in ECG ST segments and T waves were monitored and recorded at 5 minutes after induction of anesthesia(T_(0)),5 minutes before renal arteriovenous opening(T_(1)),30 minutes after renal arteriovenous opening(T_(2)),30 minutes after pancreatic related arteriovenous opening(T_(3)),immediately after surgery(T_(4)),4 hours after surgery(T_(5)),24 hours after surgery(T_(6)).The number of intraoperative circulating perfusion,hypertension or hypotension,myocardial ischemia and ventricular premature beats were recorded.Results Compared with T_(0),the concentrations of TNF-α,IL-18,cTnI,and CK-MB were significantly increased at T_(2)-T_(6) in groups C and U(P<0.05),the concentrations of IL-6 was significantly increased in group C at T_(2)-T_(5)(P<0.05),and the concentration of IL-6 was significantly increased in group U at T_(3)(P<0.05).Compared with group C,the concentrations of TNF-α,cTnI,and CK-MB were significantly reduced in group U at T_(2)-T_(6)(P<0.05),the concentration of IL-6 was significantly reduced in group U at T_(2)-T_(4)(P<0.05),and the concentration of IL-18 was signif

关 键 词：乌司他丁 胰-肾联合移植术 心肌损伤 

分 类 号：R969[医药卫生—药理学]