乌司他丁对亲体肝移植术患儿心肌损伤的影响

Effects of ulinastatin on myocardial injury in pediatric patients undergoing living-related liver transplantation

目的探讨乌司他丁对亲体肝移植术患儿心肌损伤的影响。方法择期全身麻醉下亲体肝移植术患儿30例，性别不限，年龄5～15个月，体重5～11kg，ASA分级Ⅲ或Ⅳ级。采用随机数字表法，将其分为2组：对照组（C组）和乌司他丁组（u组），每组15例。U组将乌司他丁2万U／kg用生理盐水稀释至1万U／ml，分别于切皮前即刻和门静脉开放前5min静脉注射1／2剂量；C组于相同时点给予等容量生理盐水。分别于切皮前即刻（T0）、无肝期30rain（T1）、新肝期3h（T2）和术毕（T1）时采集中心静脉血样，检测血清心肌肌钙蛋白I（cTnI）、乳酸脱氢酶（LDH）和α-羟丁酸脱氢酶（α-HBDH）水平。记录术中多巴胺使用情况、心血管不良事件（高血压或低血压、心肌缺血和室性早搏）的发生情况。计算T。时血清cTnI、LDH和d—HBDH水平的变化率。结果与C组比较，U组T2，3时血清cTnl、LDH和Ot—HBDH水平及其变化率降低（P〈O．05或0．01），心血管不良事件发生率和多巴胺使用率差异无统计学意义（P〉0．05）。结论乌司他丁可减轻亲体肝移植术患儿心肌损伤。

Objective To investigate the effects of ulinastatin on myocardial injury in pediatric patients undergoing living-related liver transplantation （LRLT）. Methods Thirty pediatric patients of both sexes, aged 5-15 months, weighing 5- 11 kg, with American Society of Anesthesiologists physical status m or IV, scheduled for elective LRLT, were equally and randomly divided into either control group （group C） or ulinastatin group （group U） using a random number table. Ulinastatin 20 000 U/kg was diluted into 10 000 U/ml with normal saline, and it was then injected intravenously in 2 parts （ 1/2 was injected before skin incision; 1/2 at 5 rain before portal vein declamping） in group U. In group C, the equal volume of normal saline was given instead of ulinastatin. Immediately before skin incision （To, baseline） , at 30 min of anhepatic phase （ T1 ） , at 3 h of neohepatic phase （ T2 ） , and at the end of surgery （T3 ） , blood samples were taken from the central vein for determination of serum cardiac troponin ] （cTnI） , lactate dehydrogenase （LDH） , and alpha-hydroxybutyrate dehydrogenase （oL-HBDH） levels. The requirement for dopamine and occurrence of adverse cardiovascular events （hypertension or hypotension, myocardial ischemia and ventrieular premature beat） were recorded during surgery. The changing rates of serum cTnI, LDH and α-HBDH levels were calculated at T1-3. Results Compared with group C, the serum cTnI, LDH and α-HBDH levels and the changing rates were significantly decreased at T2,3, and no significant changes were found in the incidence of adverse cardiovascular events and requirement for dopamine in group U. Conclusion Ulinastatin can attenuate the myocardial injury in pediatric patients undergoing LRLT.