乌司他丁对老年人胃肠道大手术围术期心脏功能的影响

Effect of ulinastatin for perioperative cardiac protection in elderly patients undergoing major gastrointestinal surgery

目的探讨在老年人胃肠道大手术中应用乌司他丁对其围术期心脏功能的影响。方法选择60例择期行胃肠道大手术的老年患者(年龄>60岁)随机分为乌司他丁组(U组)和对照组(C组)。U组在人室静脉开放后即开始采用微量泵快速泵入乌司他丁200 000 U,于手术开始前泵完,接着持续静脉泵入乌司他丁100 000 U/h至手术结束。C组给予同等剂量的生理盐水。监测两组手术开始前(T0),手术开始后1 h(T1),开始后2 h(T2),开始后3 h(T3)的平均动脉压(MPV)、心率(HR),通过床旁多普勒超声心动图监测两组上述各时间点的左室射血分数(LVEF)和心输出量(CO),记录两组患者术毕时多巴胺总的用量。并在手术开始前(T0),手术结束后6 h(T4)和手术结束后12 h(T5)采集两组患者右颈内静脉血检测血清的肌钙蛋白(cTn)、肌酸激酶同工酶(CK-MB)、脑钠肽(BNP)的含量。结果两组在T2和T3时的MPV、LVEF和CO较T0时均显著降低(P<0.05),HR显著升高(P<0.05),两组在T4和T5时的cTn、CK-MB和BNP较T0时显著升高。但C组与U组相比在T2和T3时MPV、LVEF和CO显著降低(P<0.05),HR显著升高(P<0.05),在T4和T5时cTn、CK-MB和BNP则显著升高。结论在老年人胃肠道大手术中应用乌司他丁对患者围术期的心脏功能有明显的保护作用。

Objective To study protective effect of ulinastatin on perioperative cardiac function in elderly patients undergoing major gastrointestinal surgery. Methods Sixty elderly patients （32 male and 28 female patients） aged 60-82 years scheduled for major gastrointestinal surgery were randomized into ulinastatin group and control group. The patients in ulinastatin group received 2×10^5 U ulinastatin rapidly administered via a intravenous pump immediately before operation with subsequent continuous infusion at the rate of 1×10^5 U until the completion of surgery, and those in the control group received the same amount of saline instead. In both groups, the mean arterial pressure （MAP）, heart rate （HR）, left ventricular ejection fraction （LVEF）, and cardiac output （CO） were monitored immediately before surgery （To） and at 1 h （T1）, 2 h （T2） and 3 h （T3） after the start of surgery. The total dopamine dose used was recorded at the end of surgery, and blood samples were collected at To and at 6 h （T4） and 12 h （T5） after the operation for determination of serum levels of cTn, CK-MB and BNP. Results In both groups, MAP, LVEF and CO were significantly decreased at T2 and T5 （P〈0.05） and serum levels of cTn, CK-MB and BNP significantly increased at T4 and T5 compared to those at To （P〈0.05）. Compared with the control group, the patients in ulinastatin group showed significantly higher MAP, LVEF and CO at T2 and T3 and lower serum levels of cTn, CK-MB and BNP at T4 and T5. Conclusion Ulinastatin offers effective perioerative cardiac protection in elderly patients undergoing major gastrointestinal surgery.