乌司他丁在全髋关节置换术控制性降压中对脑氧代谢的影响

Effects of ulinastatin combined controlled hypotension on cerebral oxygen metabolism in patients undergoing artificial hip replacement

目的观察乌司他丁联合控制性降压在全髋关节置换术中对患者的脑氧代谢影响。方法 36例择期全髋关节置换术患者随机分为两组:硝酸甘油组(Ⅰ组)和硝酸甘油联合乌司他丁组(Ⅱ组)。两组于麻醉诱导前静脉滴入平衡液500～800 ml,Ⅱ组于液体中加入乌司他丁5000μ/kg。手术开始前行硝酸甘油控制性降压,于降压前即刻(T_0)、降压后30 min(T_1)、降压后45 min(T_2)和复压后30 min(T_3)四个时间点分别抽取桡动脉及颈内静脉球部血液行血气分析及乳酸含量测定。记录术中出血量及术后24 h刀口引流量。结果两组患者HR和MAP比较无统计学意义。Ⅱ组患者较Ⅰ组患者颈静脉球部血氧饱和度(SjvO_2)更高(P<0.05),脑氧摄取率(CERO_2)更低(P<0.05)。两组降压期间颈内静脉-动脉血乳酸含量差值L(jv-a)Ⅱ组变化无统计学意义,Ⅰ组明显升高。Ⅱ组较Ⅰ组24 h引流量更少。结论乌司他丁联合控制性降压可以降低脑氧代谢,减少乳酸生成,从而能更好的有利于手术中实行脑保护,并且减少术后出血量,对血液保护可能有一定作用。

Objective To study the effects of ulinastatin combined controlled hypotension on cerebral oxygen metabolism in patients undergoing artificial hip replacement. Methods Thirty six patients undergoing artificial total hip replacement were randomized into two groups ： Nitroglycerin Group （ Ⅰ）, and Nitroglycerin combined Ulinastatin Group （ Ⅱ ）. Solution 500 - 800 ml were infused in both groups, and 5000 μ/kg ulinastatin was added in solution at Group Ⅱ. Controlled hypotension was exeuted before operation. Blood gas analysis and lactic acid were monitored by taking blood samples from right intenal jugular vein bulb and radial artery at the moments of the controlled hypotension （ T0） ,30 minutes （ T1 ） and 45 minutes （ T2 ） after controlled hypotension and 30 minutes after the controlled hypotension stopped（ T3 ）. The bleeding volume during operation and the volume of 24 hours＇ draining were recorded. Results Patients＇ HR and MAP were similar between two groups. During controlled hypotension the SjvO2 of Group Ⅱwas increased significantly than that of Group I ;The CERO2 in Group Ⅱ decreased siguifieantly than it in groupI（ P 〈 0. 05 ）. The L（jva）in Group [ inceased significantly,while those of Group II didn＇t. The volume of drainage in Group Ⅱ were less than those in Group I Conclusion During controlled hypotension ulinastatin could improve cerebral oxygen metabolism, decrease blood lactic acid level and play a role in cerebral protection, so it could decrease bleeding after operation too.