乌司他丁对原位肝移植术患者围术期促炎性细胞因子和氧自由基代谢的影响  

Effects of ullnastatin on proinflammatory cytokines and oxygen free radicals during orthotopic liver transplantation

作　　者：张欢[1] 乔青[1] 杨拔贤[1] 苟淑琴[1] 张秀华[1] 

机构地区：[1]北京大学人民医院麻醉科,100044

出　　处：《中华麻醉学杂志》2003年第5期325-327,共3页Chinese Journal of Anesthesiology

摘　　要：目的 观察持续输注乌司他丁对原位肝移植术(OLT)患者围术期血浆促炎性细胞因子和氧自由基代谢水平的影响并探讨其作用机制。方法 将18例晚期肝病患者,ASAⅢ-Ⅳ级,择期行OLT手术,随机分为2组。乌司他丁组(U组,n=9):切皮后将乌司他丁20万单位加入100 ml生理盐水,持续静脉输注,之后每4小时重复使用。对照组(c组,n=9):以等容量生理盐水代替。分别于麻醉后切皮前、无肝前期120min、无肝期30min、新肝期5min、新肝期60min和术毕抽取静脉血测定血浆IL-6、IL-8、TNF-α和丙二醛(MDA)浓度。无肝期使用静脉-静脉转流(VVB)。术中吸入氧浓度(FiO2)为100％。连续测定心输出量、混合静脉血氧饱和度及中心静脉血温,监测ECG、CVP、PETCO2、SpO2、桡动脉压、肺动脉压。维持血温不低于35.5℃。结果 C组IL-6和IL-8浓度从无肝前期120 min开始至术毕显著高于切皮前(P<0.05);无肝前期和无肝期TNF-α和MDA水平与切皮前相比差异无显著性(P>0.05),新肝期5 min开始明显高于切皮前水平(P<0.01)。U组各项参数除新肝期5 min IL-6和IL-8水平高于切皮前外,其余时间点与切皮前差异均无显著性(P>0.05),且明显低于C组各相应时间点水平(P<0.05)。结论肝移植围术期持续输注乌司他丁可以抑制IL-6、IL-8和TNF-α等促炎性细胞因子的生成和释放,?Objective To evaluate the effects of ulinastatin on proinflamatory cytokines and oxygen free radical during orthotopic liver transplantation (OLT). Methods Eighteen ASA Ⅲ-Ⅳ patients with end-stage liverⅣ diseases, undergoing OLT were randomly divided into two groups: (1) ulinastatin group received intravenous infusion of ulinastatin 2× 105 IU in 100 normal saline after skin incision and every 4 hours thereafter (group U n = 9); control group received same amount of normal saline instead of ulinastatin (group C n = 9). Anesthesia was induced with midazolam 0.1-0.2 mg·kg-1 , fentanyl 5 μg·kg-1 and pipecuronium 0.1 mg·kg-1 and maintained with isoflurane inhalation and intermittent iv boluses of fentanyl and pipecuronium combined with epidural anesthesia(T8.9). The patients were mechanically ventilated with 100% O2 and PETCO2 was maintained at 35-40 mm Hg during operation. Swan-ganz catheter was inserted via right internal jugular or subclavian vein after induction of anesthesia. Cardiac output, mixed venous oxygen saturation and central venous temperature were continuously monitored with continuous cardiac output monitor (Baxter, Vigilance). ECG,CVP,SpO2 and PETCO2 were also continuously monitored during operation. Radial artery was cannulated for continuous direct blood pressure monitoring. Blood samples were taken before skin incision (T0), 120 min after skin incision (T1), 30 min after liver was removed ( anhepatic phase) (T2) , 5 min and 60 min after reperfusion of the graft (T3 , T4) and at the end of operation (T5 ) for determination of plasma IL-6, IL-8, TNF-α and MDA concentration. Body temperature was maintained above 35.5℃ during operation. Venovenous bypass was performed during anhepatic phase. Results (1) In group C plasma IL-6 and Ⅱ-8 concentrations were significantly increased from T1-5 during operation as compared with the baseline values (T0), whereas plasma levels of TNF-α and MDA did not change significantly before and during anhepatic phase (T1 , 2) but were significantly increase

关 键 词：乌司他丁 胰蛋白酶抑制剂 肝移植术 促炎性细胞因子 氧自由基 

分 类 号：R657.3[医药卫生—外科学]