乌司他丁对瓣膜置换术患者肾脏的保护作用

The protective effect of ulinastatin on kidneys of patients undergoing prosthetic valve replacement

目的探讨乌司他丁对心脏瓣膜置换术患者肾脏的保护作用。方法53例心脏瓣膜置换术患者随机分为两组,试验组(U组,n=30),对照组(C组,n=23)。试验组术中予乌司他丁2万U/kg静脉注射,对照组给生理盐水。于术前30min,主动脉阻断前5min,主动脉开放后5min,手术结束时,以及术后第1、3、5天查尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、尿肌酐(Cr),求两者比值NAG/Cr,测血BUN、Cr,并记录尿流率及术后速尿使用总量。结果主动脉开放后5min、手术结束时、术后第1天试验组尿NAG/Cr值低于对照组(P<0.05);尿流率高于对照组(P<0.05);试验组术后速尿使用总量少于对照组(P<0.05);两组间血清BUN、Cr差异无统计学意义。结论心脏瓣膜置换术中使用乌司他丁有利于肾脏保护。

Objective To investigate the protective effect of ulinastatin （UTI） on kidneys of patients subjected prosthetic valve replacement during perio-operative period. Methods Fifty-three patients undergoing prosthetic valve replacement were randomly divided into two groups： UTI group （n=23） and control group （n=30）. In UTI group, each patient get UTI 20,000 U/kg body weight intravenously during the operation. Urinary and blood sample was taken from the patient at the time of 30 min before operation （T1）, 5 min before aorta cross-clamping （T2）, 5 min after reperfusion （T3）, at the end of the operation （T4）, 1, 3 and 5days （T5, T6, T7） after operation respectively. NAG, urinary creatine （Cr）, NAG/Cr, urinary flow rate, BUN, blood creatine were detected. The total dose of postoperative furosemide was recorded too. Results Compared with control group, NAG/Cr and the total dose of furosemide in UTI group significantly decreased at T3, T4, T5. There was no significant difference of BUN, blood creatine level between two groups. Conclusion There are some protective effects of UTI on renal function of patients with prosthetic valve replacement.