乌司他丁对活体肝移植术患者心肌损伤的影响

Effects of ulinastatin on myocardial injury in patients undergoing live donor liver transplantation

目的评价乌司他丁对活体肝移植术患者心肌损伤的影响。方法择期活体肝移植术患者40例，年龄4J0～64岁，体重指数18～25kg／m2，AHA心功能分级A或B级，采用随机数字表法，将其随机分为2组（n=20）：对照组（C组）和乌司他丁组（U组）。u组于麻醉诱导后30min内静脉输注乌司他丁300000IU（溶于100ml生理盐水），每4h重复静脉输注300000IU，直至术毕。于切皮前即刻（T0）、无肝期30min（T1）、新肝期30min（T2）、术毕（T3）、术后4h（T4）及24h（T5）时，采集中心静脉血样，采用电化学发光免疫法分别测定血清氨基末端-脑钠肽前体（NT-proBNP）、心肌肌钙蛋白I（cTnI）和磷酸肌酸激酶同工酶（CK—MB）的浓度。计算T1-5时血清NT-proBNP、cTnI和CK-MB浓度的变化率，记录术中心血管活性药物使用情况及心血管事件发生情况。结果与T0时比较，两组T2～5时血清cTnI、CK—MB和NT-proBNP的浓度升高（P〈0．05）；与C组比较，u组T2-5时血清cTnI、CK—MB和NT—proBNP的浓度降低（P〈0．05）；C组cTnI、CK—MB和NT-proBNP浓度最大变化率为4．71±1．62、6．85±1．53、4．96±1．23，U组降低为3．26±1．51、4．56±1．62、3．67±1．02。两组心血管不良事件发生率和多巴胺使用率比较差异无统计学意义（P〉0．05）。结论静脉输注乌司他丁可在一定程度上减轻肝移植术患者心肌损伤。

Objective To investigate the effects of ulinastatin on the myocardial injury in patients undergoing live donor liver transplantation. Methods Forty patients （AHA classification grade A or B）, aged 40-64 yr, with a body mass index of 18-25 kg/m：, scheduled for live donor liver transplantation, were randomly divided into 2 groups （n = 20 each） ： control group （group C） and ulinastatin group （group U）. Anesthesia was induced with midazolam, sufentanil, and cisatracurium besilate. The patients were tracheal intubated and mechanically ventilated. Ulinastatin 300 000 IU in 100 ml of normal saline was infused intravenously over 30 min after anesthesia induction and then the infusion was repeated at 4 h interval until the end of operation in group U, while the equal volume of normal saline was given in group C. Blood samples were taken from the central vein immediately before skin incision （T0 , baseline）, at 30 min of anhepatic phase （T1）, at 30 min of neohepatic phase （T2）, and at 0, 4 and 24 h after operation （T3-5） for determination of the concentrations of serum cardiac troponin I （cTnI）, creatine kinase-MB （CK-MB） and N-terminal pro-brain natriuretic peptide （NT-proBNP）. The changing rates of cTnI and CK-MB at T1-5 were calculated. The use of cardiovascular drugs and cardiovascular accidents were recorded during operation. Results The serum cTnI, CK-MB and NT-proBNP concentrations were significantly higher at T2-5 than at To in the two groups （ P 〈 0.05） . Compared with group C, the serum cTnI, CK-MB and NT-proBNP concentrations at T2-5 were significantly deceased in group U （P 〈 0.05）. The maximal changing rates of cTnI, CK-MB and NT-proBNP concentrations were 4.71 ± 1.62, 6.85 ± 1.53 and 4.96 ± 1.23 respectively in group C, decreased to 3.26 ± 1.51, 4.56 ± 1.62 and 3.67 ± 1.02 respectively in group U. There was no significant difference in the incidence of cardiovascular accidents and the use of dopamine between the two groups. Conclusion Intravenous infusion of ulinastatin can attenuate the myocardial injury to some extent in patients undergoing live donor liver transplantation.