乌司他丁预先给药对CO2气腹致腹腔镜妇科手术患者心肌损伤的影响

Effect of ulinastatin pretreatment on myocardial injury induced by carbon dioxide pneumoperitoneum in patients undergoing laparoscopic gynecologic stwgery

目的评价乌司他丁预先给药对CO2气腹致腹腔镜妇科手术患者心肌损伤的影响。方法择期腹腔镜下行妇科恶性肿瘤切除术的患者30例，ASAⅠ或Ⅱ级，年龄30～60岁，体重50～70k，随机分为2组（n=15）：对照组（C组）和乌司他丁预先给药组（U组）。U组气管插管后30min内静脉输注乌司他丁1万U／kg，C组以等量生理盐水替代。维持CO2气腹压力1．3～1．9kPa。于麻醉诱导前即刻（基础状态）及术后8h时采集静脉血样，测定血清肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、谷草转氨酶（AST）和乳酸脱氢酶（LDH）的活性。结果与基础值比较，C组术后8h时血清CK和AST的活性升高（P〈0．05），血清CK—MB和LDH的活性和U组各指标差异无统计学意义（P〉0．05）。与C组比较，U组术后8h时血清CK和AST的活性下降（P〈0．05），血清CK-MB和LDH的活性差异无统计学意义（P〉0．05）。结论预先静脉输注乌司他丁1万U／kg对腹腔镜妇科手术患者心肌可产生保护作用。

Objective To investigate the effect of ulinastatin pretreatrnent on the myocardial injury induced by CO2 pneumopefitoneurn in patients undergoing laparoseopie gynecologic surgery. Methods Thirty ASA Ⅰ or Ⅱ patients, aged 30-60 yr, weighing 50-70 kg, scheduled for laparoseopic gynecologic surgery were randomized to 2 groups （n = 15 each） ： control group （group C） and ulinastatin pretreatment group （group U）. The patients were prernedicated with intramuscular phenobarbital sodium 2 mg/kg and atropine 0.01 mg/kg. Anesthesia was induced with midazalarn 0.1 mg/kg, etomidate 0.5 mg/kg, fentanyl 4 μg/kg and rocuroniurn 0.8 mg/kg. The patients were tracheal intubated and mechanically ventilated. Group U received iv infusion of ulinastatin 10 000 U/kg over 30 min following tracheal intubation, while group C equal volume of normal saline instead. The intra-abdominal pressure was maintained at 1.3-1.9 kPa. Anesthesia was maintained with propofol 6 mg· kg^-1 · h^-1 , remifentanil 0.1 μg· kg^-1 ·min^-1 , and intermittent injection of veeuronium, Venous blood samples were collected immediately before anesthesia induction （baseline） and 8 h after operation for the measurement of the serum creatine kinase （CK）, asparatate arninotransferase （AST）, ereatine kinase-MB （CK-MB） and lactate dehydrogenase （LDH） activities. Results Compared with the baseline values, the activities of all serum myocardial enzymes did not change significantly 8 h after surgery in group U （ P 〉 0.05）, while the activities of serum CK and AST were significantly increased in group C （P 〈 0.05）. The activities of serum CK and AST were significantly lower in group U than in group C （P 〈 0.05）. There were no significant differences in serum CK-MB and LDH activities between two groups （P 〉 0.05 ）. Conclusion Pretreatment with ulinastatin 10 000 U/kg can protect myocardium in patients undergoing laparoscopic gynecologic surgery.