乌司他丁对原位肝移植术中肾功能的影响

Effects of ulinastatin on renal function during orthotopic liver transplantation

目的观察乌司他丁(UTI)对原位肝移植术(OLT)手术中肾功能的影响。方法将40例择期行OLT手术患者随机分为对照组和UTI组。UTI组(U组,n=20):切皮后将UTI 30万U加入100 ml生理盐水,持续静脉输注,之后每4 h重复一次。对照组(C组,n=20):以等容量生理盐水代替。观察麻醉前和术毕时血Bun、Cr及尿NAG、RBP、α1-MG、γ-GTP。术中连续监测心输出量、混合静脉血氧饱和度、中心温度、ECG、CVP、PETCO2、SpO2、桡动脉压、肺动脉压。维持中心温度不低于35.5℃。结果术毕时:两组患者血Bun、Cr均高于麻醉前,但差异无统计学意义。C组患者尿γ-GPT和NAG均分别较麻醉前高(P<0.05),而U组患者尿γ-GPT和NAG虽有升高,但与麻醉前比较差异均无统计学意义,但此时U组二者均分别较C组低(P<0.05);U组患者尿α1-MG和C组患者尿α1-MG及尿RBP均分别较麻醉前明显升高(P<0.01),但此时U组二者均分别较C组低(P<0.05)。结论UTI对OLT手术中的肾功能确有一定保护作用。

Objective To investigate the protective effects of ulinastatin on renal function during orthotopic liver transplanlation （OLT）.Methods A total of 40 patients receiving OTL were divided into the control group （ n =20） and treated group （ n =20）.Ulinastatin group received intravenous infusion of ulinastatin 3 × 10^5 IU in 100 ml normal saline after skin incision and every 4 hours thereafter. Control group received the same amount of normal saline instead of ulinastatin. Bun, Cr, urine - N - acetyl - beta - D - glucosaminidase （u - NAG） ,urine- γ- GTP,urine- α1 - microglobulin （ u- α1 - MG） ,and urine retinal binding protein （u- RBP） were measured before anesthesia and after OLT. After induced anesthesia, 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 After operation, the BUN and Cr levels in both groups were higher than those anesthesia, but the differences were not significant （ P 〉 0.05）. The levels of γ - GTP,NAG,RBP,and α1 - MG significantly increased in the control group（ P 〈 0.01 ）, while only α1 - MG obviously increased in the ulinastatin group （ P 〈 0.01 ）. The levels of α1- MG and RBP in group U were significantly lower than those in group C （ P 〈 0.05）. Conclusions Ulinastatin can protect renal function during OLT.