乌司他丁对肝移植患者术中血流动力学的保护作用

Protection of ulinastatin on hemodynamics in the patients undergoing orthotopic liver transplantation

目的探讨乌司他丁对肝移植患者术中血流动力学的保护作用。方法将96例行同种异体非转流原位肝移植的终末期肝病患者分层随机分为两组：乌司他丁组（U组，n=48）和对照组（C组，n=48）。观察并分别记录麻醉后、无肝前期（Tn）、肝下下腔阻断30min（T1）、肝下下腔开放30min（T2）、肝下下腔开放60min（T3）、肝下下腔开放120min（T4）和手术结束时（T5）两组患者的心输出量（CCO）、平均动脉血压（MABP）、体循环阻力（SVR）、平均肺动脉压（MPAP）及肺毛细血管嵌压（PAWP）等血流动力学参数。结果两组患者无肝前期CCO、MABP、MPAP、PAWP和右心室射血分数（RVEF）均明显下降（P〈0．01），SVR明显升高（P〈0．01）；开放肝血流后30min，两组患者MABP和RVEF开始回升，但仍明显低于无肝前期（P〈0．01，P〈0．05），SVR较无肝前期明显下降；再灌注后60min，U组患者CCO、MABP和RVEF恢复至无肝前期水平，SVR明显高于无肝前期，MPAP和PAWP基本正常或接近于正常范围。两组比较差异有统计学意义（P〈0．05，P〈0．01）。结论乌司他丁能够改善移植肝脏缺血再灌注综合征，降低血管活性药物的使用量，对原位肝移植患者血流动力学的稳定性具有良好的保护作用。

Objective To explore the protection of ulinastatin on hemodynamics in the patients with liver transplantation. Methods 96 patients with orthotopic liver transplantation without bypass were randomly divided into ulinastatin group （group U, n = 48 ） and control group （group C, n = 48 ）. Hemodynamic parameters including CCO, MABP, SVR, MPAP, PAWP and RVEF were recorded at postanesthetic and preanhepatic phase, clamping postcava 30 min, opening postcava 30 min, opening postcava 60 min, opening postcava 120 min and the end of operation respectively. Results The CCO, MABP, MPAP, PAWP and RVEF decreased significantly, the SVR increased obviously at anhepatic phase in two group patients （ P 〈0. 01 ）. The MABP and RVEF started to recover at opening postcava 30 min, but still lower than at preanhepatic phase, the SVR decreased obviously compared with anhepatic phase in two groups （P 〈 0. 05 -0.01 ）. The CCO, MABP, RVEF recovered to the level of preanhepatic phase, the SVR was higher significantly than at preanhepatic phase and MPAP, PAWP were nearly normal at opening postcava 60 min in group U. There were significant differences between the two groups （ P 〈 0. 05 - 0. 01 ）. Conclusion Ulinastatin can ameliorate ischemia - repeffusion syndrome and reduce the use of vasoactive medicines, which may play an important role in keeping hemodynamic stability.