乌司他丁早期应用于老年人上腹部手术的临床疗效

Clinical effects of ulinastatin early application in the old patients with upper abdominal surgery

目的探讨乌司他丁在老年人上腹部手术中早期应用的临床疗效。方法选取同期40例上腹部手术老年患者(年龄>60 a)随机分为乌司他丁组(U组)和对照组(C组)。U组在入室静脉开放后即开始采用微量泵快速泵入乌司他丁20万U,于手术开始前泵完,接着持续静脉泵入乌司他丁10万U·h-1至手术结束。检测2组术前1 d、术后1、3、5 d血清肿瘤坏死因子(TNF-α)、白介素(IL-6、IL-8)及丙氨酸转氨酶(ALT)、血肌酐(Scr)、肌酐清除率(Ccr)、血和尿中α1微球蛋白(α1-mG)。结果术后TNF-α、IL-6和IL-8 U组明显低于C组(P<0．05);U组术后1-5 d血清Scr、Ccr水平与术前相比差异无统计学意义(P> 0．05),而C组术后血清Scr水平较术前明显升高(P<0．05),Ccr下降与U组同期相比差异有统计学意义(P<0．05);U组与C组术后血清ALT、血和尿中α1-mG水平较术前均明显升高,但U组升高的幅度均小于C组(P<0．05),且U组各指标恢复速度更快,优于C组。结论早期应用乌司他丁可通过抑制炎症反应,防御组织损伤,对老年人上腹部手术的围手术期肝肾功能具有保护作用。

AIM To explore the clinical effects of ulinastatin early application in the old patients with upper abdominal surgery. METHODS Forty patients were randomly divided into treatment group （group U）and control group （group C） .In group U（ n = 20） ,2 × 10^5 units of nlinastatin were given intravenously before operation, then the dosage of 1 × 10^5 units were continuously used up to postoperation. In control group（ n = 20）, the patients didn＇t received protective drugs. The levels of IL-6, IL-8, TNF-α and ALT, Scr, Ccr, α1-mG were detected in both groups befroe and after operations. RESULTS ①Serum TNF-α, IL-6 and IL-8 concentrations in treatment group were significantly lower than those in control group on the 1,3 and 5 d after operation（ P 〈 0.05）. ②Scr and Ccr levels after operation in treated group were no significant difference in comparison with before operation（ P 〉 0.05）. The level of Scr was obviously elevated after operation, but the level of Ccr was decreased as compared with the level before operation in control group（ P 〈 0.05）. The levels of ALT, al-mG in both groups were obviously elevated after operation. As compared with control group, the decreased velocity in group U was remarkable quick. CONCLUSION Ulinastatin early application can inhibit the inflammatory factors release and protect the liver and kidney functions for patients.