术中应用乌司他丁对重型肝炎患者肝移植后急性肾功能衰竭的影响

Protective effects of ulinastatin during orthotopic liver transplantation on kidney function with decreasing acute renal failure after liver transplantation in patients with severe hepatitis

目的研究术中应用乌司他丁是否能减少重型肝炎患者肝移植术后急性肾功能衰竭的发生。方法31例术前血肌酐、尿素氮正常的重型肝炎患者行改良背驮式原位肝移植术，均未采用体外静脉．静脉转流。数字随机法分为2组：乌司他丁组（U组，n=15例）和对照组（C组，n=16例），分别于术前、术后24h分别抽取桡动脉血测定β2-微球蛋白（β2-MG）值、肌酐、尿素氮及留取新鲜尿液测定尿β2-MG值，记录两组患者术后肝移植相关性肾功能衰竭的发生率以及术后转归等情况。结果术后24h乌司他丁组有4例而对照组有10例发生肝移植相关性肾衰（P〈0．05）。术后24h发生的急性肾功能衰竭（ARF）的患者乌司他丁组4例均不需要血透治疗，治愈出院；而对照组ARF有4例需要进行血透，2例死亡，3例病情未愈但自动出院，5例治愈出院；两组术后24h血、尿β2-MG、肌酐、尿素氮均较术前明显增高（分别为P〈0．05和P〈0．01），两组间比较，对照组术后24h血、尿β2 MG、尿素氮值均明显高于乌司他丁组（分别为P〈0．05和P〈0．01）。结论术中应用乌司他丁对重型肝炎患者肝移植围术期的肾功能具有保护作用，能减少肝移植相关性肾衰的发生率。

Objective To study whether using ulinastatin （UTI） during orthotopic liver transplantation （OLT） can decrease acute renal failure after liver transplantation in patients with Severe Hepatitis. Method Thirty-one patients with Severe Hepatitis undergoing orthotopic liver transplantation （OLT） were studied. They were devided into two groups ： determination of serum[32 microglobulin（ [32 MG）, BUN and Cr before operation and 24 h after operation, at the same time, urine samples were taken for determination of urine [32 MG. Data of HR, ABPM, CVP, CO were recorded during operation. The Incidence of renal failure affiliated liver transplantation（RFALT） and prognosis of these patients were also recorded in the two groups after operation. Results （ 1 ）4 cases in group U while 10 cases in group C developed RFALT at 24 h after operation（P 〈0.05）. In these patients who developed RFALT at 24 h after operation ,4 cases were all rehabilitation discharge in group U, while in group C ,2 cases died,3 cases didn＇t cure but required discharge ,only 5 cases were rehabilitation discharge. （2） Compared with baseline before operation, serum [32 MG, Urine [32 MG, BUN and Cr increased significantly at 24 h after operation both in two groups, （P 〈 0. 05, P 〈 0. 01 ）. （3）Compared with group C, serum [32 MG, Urine [32 MG, BUN increased significantly at 24 h after operation in group U （ P 〈 0. 05, P 〈 0. O1 ）. Conclusion Protective effects of ulinastatin during orthotopic liver transplantation on kidney function in patients with Severe Hepatitis can decrease acute renal failure after liver transplantation.