乌司他丁对原位肝移植术患者围术期肾功能的影响

Effect of ulinastatin on perioperative renal function in patients undergoing orthotopic liver transplantation

目的评价乌司他丁对原位肝移植术患者围术期肾功能的影响。方法拟行原位肝移植术的患者60例，性别不限，年龄35-64岁，体重50～75kg，ASA分级Ⅱ或Ⅲ级，血肌酐（Cr）和尿素氮（BUN）未见异常。采用随机数字表法，将患者随机分为2组（n=30）：对照组（C组）和乌司他丁组（U组）。麻醉诱导后U组经1h静脉输注乌司他丁400000IU（溶于20ml生理盐水中），然后每4h重复静脉输注200000IU，直至术后48h；C组给予等容量生理盐水。于无肝前期、无肝期和新肝期记录尿量和呋塞米用量。分别于麻醉诱导前（TJ）、无肝期15min（E）、新肝期15min（T1）、术毕（T4）和术后48h（T5）时采集静脉血和尿液标本，测定血清BUN和Cr的浓度、肌酐清除率和尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）活性、微量白蛋白浓度。结果与C组比较，U组无肝期和新肝期呋塞米用量减少，尿量增加，T2-5时血清Cr浓度降低，肌酐清除率升高，T4，5时尿NAG活性和微量白蛋白浓度降低，T3-5，时血清BUN浓度降低（P〈0．05）。结论乌司他丁对原位肝移植术患者围术期肾功能有一定的保护作用。

Objective To investigate the effect of ulinastatin on perioperative renal function in patients undergoing orthotopic liver transplantation. Methods Sixty ASA Ⅱ or Ⅲ patients of both sexes aged 35-64 yr weighing 50-75 kg with normal blood urea nitrogen （BUN） and creatinine （Cr） before operation undergoing orthotopic liver transplantation were randomly divided into 2 groups （ n = 30 each） ： control group （group C） and ulinastatin group （ group U） . Anesthesia was induced with midazolam, fentanyl, etomidate and vecuronium and main- tained with isoflurane inhalation, propofol TCI, continuous remifentanil infusion and intermittent iv boluses of fentanyl and vecuronium. The patients were tracheally intubated and mechanically ventilated. PrTCO2 was maintained at 30-35 mm Hg. Ulinastatin 400 000 IU in normal saline 20 ml was infused iv after induction of anesthesia. Ulinastatin 200 000 IU was then infused every 4 h until 48 h after operation. Urine volume and the amount of furosemide administered were recorded before anhepatic phase, and during anhepatic and neohepatic phase. Venous blood samples and urine were collected before induction of anesthesia （%）, at 15 min of anhepatic phase （T2）, at 15 rain of neohepatic phase （ T3 ）, at the end of operation （T4） and 48 h after operation （T5 ） for determination of serum concentrations of BUN, Cr and creatinine clearance rate and urinary N-acetyl-beta-D-glucosaminidase （NAG） activity and microalbumin concentration. Results Compared with group C, ulinastatin significandy decreased the amount of furosemide administered and increased urine volume during anhepatic and neohepatic phase, decreased serum Cr concentration, increased creatinine clearance rate at T2-5, decreased urinary NAG activity and microalbumin concentration at T4-5 and serum BUN concentration at T3-5 . Conclusion Ulinastatin has protective effect on renal function during perioperative period in patients undergoing orthotopic liver transplantation.