乌司他丁对原位肝移植术中肺氧合功能的影响

Effects of ulinastatin on pulmonary gas exchange and intrapulmonary shunt during orthotopic liver transplantation

目的观察乌司他丁(UTI)对原位肝移植术(OLT)围术期肺氧合功能及肺内分流的影响。方法20例择期行OLT患者,随机分为两组。UTI组(U组,n=10):切皮后将UTI100万单位加入100ml生理盐水中,持续静脉输注1h,之后每4小时重复一次;对照组(C组,n=10):以等容量生理盐水代替。分别于麻醉后切皮前(T1)、无肝前期120min(T2)、无肝期30min(T3)、新肝期5min(T4)、60min(T5)和术毕(T6)抽取桡动脉和肺动脉血作血气分析,记录不同时段的PaO2、PaCO2和心脏指数(CI)。根据公式计算肺泡-动脉氧分压差(PA-aDO2)、肺内分流率(Q.s/.Qt)、氧供指数(DO2I)和氧耗指数(.VO2I)。术中连续监测心输出量(CO)、混合静脉血氧饱和度(SV-O2)、中心温度、桡动脉压、肺动脉压(PAP)、ECG、CVP、PETCO2、SpO2,维持中心温度不低于35·5℃。结果两组T1时PA-aDO2与.Qs/Q.t均高于正常值。与T1时相比,T2时各指标差异无显著意义;T3时PaO2增高(P<0·05,P<0·01),U组PA-aDO2降低(P<0·05);T4时PaCO2增高(P<0·01);T5时U组CI增高(P<0·05);T6时C组CI增高(P<0·05),U组PaO2、CI、DO2I、V.O2I均增高(P<0·05,P<0·01),U组PA-aDO2降低(P<0·05)。T6时,与C组相比,U组Q.s/Q.t、PA-aDO2和V.O2I差异有显著意义(P<0·05)。结论OLT术前和术中有明显的肺氧合功能障碍,UTI可改善OLT中肺的氧合功能。

Objective To evaluate the effects of ulinastatin on pulmonary gas exchange and intrapulmonary shunt during orthotopic liver transplantation（OLT）. Methods Twenty patients with end-stage liver diseases undergoing OLT were randomly divided into two groups. Ulinastatin group received intravenous infusion of ulinastatin 10 × 10%5 IU in 100 ml normal saline after skin incision and every 4 hours thereafter（ n= 10）. Control group received the same amount of normal saline instead of ulinastatin（n=10）. Arterial and mixed venous blood samples were taken before skin incision, at 120 rain after skin incision,30 rain after liver removed, 5 rain and 60 rain after reperfusion of the graft and at the end of operation. Alveolar-arterial oxygen partial pressure difference（PA-aDO2 ） ,intrapulmonary shunt（Qs/Qt）,oxygen delivery index（DO2 I） and oxygen consumption（VO2I） were calculated. After anesthesia induction, cardiac output, mixd venous oxygen saturation and central venous temperature were continuously monitored during operation. ECG, CVP, SpO2, PETCO2, Radial artery and MPAP were also continuously monitored during operation. PETCO2 was maintained at （35-40） mmHg during operation. Blood temperature was maintained above 35.5℃ during operation. Results At the beginning of operation, PA-aDO2 and Qs/Qt were all higher than normal values in both groups. There were no significant changes in all parameters 120 rain during preanhepatic stage as compared with those at the beginning of operation. During anhepatic stage, PaO2 increased significantly in both groups（P〈 0.05） and PA aDO2 in ulinastaun group decreased significantly（P〈0.05）. At 5 rain during neohepatic stage, PaCO2 increased significantly in two groups（P〈0.05）. At 60 rain during neohepatic stage, cardiac index（CI） in ulinastatin group increased significantly（P〈0. 05）. At the end of operation, CI in control group increased significantly （P 〈 0.05） and PaO2, CI, DO2 I, VO2I in ulinastatin group increased significantly（P 〈 0. 05）. Qs/Qt and PA-aDO2 in ulinastatin group decreased significantly （P^0. 05）. There were more significant change in Qs/Qt, PA-aDO2 and VO2I in ulinastatin group than those in control group （P〈0.05）. Conclusion There are severe changes of pulmonary gas exchange during OLT. Ulinastatin can improve pulmonary gas exchange during OLT.