乌司他丁对骨科高龄患者手术后肾功能的影响

The effects of ulinastatin on renal function of elderly patients after Orthopaedic surgical operation in perioperative phase

目的观察骨科高龄患者手术期应用乌司他丁对肾功能的保护作用。方法选择同期32例骨科高龄手术患者,年龄70～86岁,随机分为治疗组(A组)和对照组(B组),治疗组(A组)在对照组(B组)治疗的基础上加用乌司他丁注射液,分别于手术当日、手术后5天内,每8小时静注乌司他丁10万单位,溶于20ml生理盐水;测定麻醉前、术毕、术后1、3、5、7天血清肌肝(Scr)、尿素氮(BuN)及尿液中N-乙酰氨基葡萄糖糖苷酶(NAG)、r-谷氨酸转肽酶(r-GTP)、al微球蛋白(al-MG)和尿液量水平。结果手术前组间血清Cr、BUN、NAG、r-GTP、al-MG的水平差异均无统计学意义(P>0.05)。与治疗组(A组)比较,对照组(B组)术后NAG,r-GTP、al-MG在各时点明显升高(P<0.01)。血清、Cr、BUN、在第1～3天明显升高(P<0.05)。两组间排尿量无明显差异,但从每分钟输液量和分钟尿量的比值(排尿量/输液量)来看,在治疗组(A组)中该比值较高(P<0.05)。结论骨科高龄患者围手术期应用乌司他丁对肾功能具有积极的保护作用。

Objective To investigate the protective of ulinastatin on renal function of elderly patients after orthopaedic operation. Methods 32 patients intend to have orthopaedic operation were equally divided into two groups randomly.The patients in the therapeutic group （group A） were treated with ulinastatin 100 kU in 100 ml sodium chloride injection ,before the beginning of anesthesia up to 2 h after operation. Again ulinastatin 100 kU in 100 m/ sodium chloride injection were used three times a day in the following 5 days,simuhameously 100 ml sodium chloride injection were administrated in patients of the control group（group B）.Venous boold samples were taken before anesthesia （baseline） ,at the end of surgery and at 1,3,5,7 days （T1-7） after operation for determination of serum nitrogen （BUN）, andcreatinine （Cr） concentrations. Urine specimens were taken for determination the levels of N-acetyl-beta-D-glucosaminidaseg （NAG）,γ-gl-utamyltranspeptidase （γ-GPT）, almicroglobulin （al-MG）,and the urine volume. Results Before anesthesia there were no significant differences in all the parameters between two groups （P〉0.05）.Compared with the baseline values,serum BUN and Cr concentration at T3 and urine levels of NAG, γ-GPT and al-MG at T1-7 significantly increased in group B （P〈0.05）.There were no significantly difference in the urine volume between two groups,but the ratio of the urine volume to the injection volume in every minute were significantly higher in group A （P〈0.05）. Conclusion Ulnastatin has the effects of protecting renal function of elderly patients after orthopaedic surgical operation and renewing renal function after operation.