乌司他丁在肝移植术中的肺保护作用

Protection of ulinastatin on the lung function for liver transplantation patients

目的观察乌司他丁对终末期肝病行肝移植术患者的肺保护作用,并探讨其作用机制。方法将47例拟行肝移植术者随机分为2组。乌司他丁组(U组)24例,切皮前将乌司他丁10kU/kg稀释至100ml生理盐水中持续静脉输注;对照组(C组)23例,以等量生理盐水代替。术中吸入氧浓度为100%,分别于手术前(用药前,T1)、无肝前期(给乌司他丁后30min,T2)、无肝期(阻断肝血流后30min,T3)、新肝期(开放肝血流后30min,T4)及术毕(缝皮后,T5)抽取动脉血做血气分析。连续监测心排出量(CO)、混合静脉氧饱和度(SvO2)、肺血管阻力指数(PVRI),抽取相应时段的肺动脉血测定白介素-6(IL-6)、白介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)浓度。结果U组T3、T4、T5时段PaO2为(351±40)mmHg、(355±38)mmHg、(349±39)mmHg,显著高于对照组这3个时段的(297±39)mmHg、(304±40)mmHg、(302±41)mmHg(P<0.05)。两组CO在无肝期与同组其他时间段相比显著降低,其他参数两组无明显不同;U组IL-6、IL-8和TNF-α在T3、T4、T5时段较对照组显著降低(P<0.05)。结论乌司他丁能显著改善终末期肝病行肝移植术患者肺功能的氧合,此作用可能与其抑制IL-6、IL-8、TNF-α等促炎性细胞因子的释放有关。

Objective To observe the protection of ulinastatin on the lung function for liver transplantation patients and its possible mechanism. Methods 47 liver transplantation patients were divided into two groups randomly. Ulinastatin group （U, n=24）： ulinastatin 10 kU/kg intravenous infusion continually during liver transplantation. And the patients control group （C, n=23）： the same volume of normal saline as in group U instead of ulinastatin. All the patients were mechanically ventilated with 100 % O2 during the operation. The arterial blood gas analysis was taken and the PaO2 and PaCO2 were recorded before operation（T1）, pre-anhepatic phase, at 30min after ulinastatin（T2）, anhepatic phase（T3）, new liver phase （T4） and after-operation （T5）. And cardiac output （CO）, mixed venous oxygen saturation （SvO2） and pulmonary vascular resistance index （PVRI） were continuously monitored through the Swan-ganz floating catheter by Vigilance multiparameter monitor. The pulmonary artery blood samples were taken during operation from T1 to T5 for the measurement of interleukin-6 （ IL-6）, IL-8 and tumor necrosis factor alpha （ TNF-α） by radioimmunoassay. Results Compared with the group C, the PaO2 increased significantly in group U from T3 to T6 （P 〈 0.05）, the CO, SvO2 and PVRI did not change. Compared with those in group C IL-6, IL-8 and TNF-α depressed significantly in group U from T3 to T5 （ P 〈 0.05）. Conclusions Ulinastatin can improve the oxygenation of lung function in liver transplantation patients. The protection maybe related with its depression to the proinflamatory cytokine （IL-6, IL-8 and TNF-α）.