乌司他丁对心肺复苏后患者肾功能影响的研究

The effect of Ulinastatin on kidney function in patients after cardiopulmonary resuscitation

目的研究乌司他丁(UTI)对心肺复苏(CPR)后患者合并急性肾损伤(AKI)的防治效果及作用机制。方法将收治的符合纳入标准的120例患者分为乌司他丁组(UTI组)60例和对照组60例,对照组给予常规治疗,UTI组在常规治疗基础上加用乌司他丁20万U缓慢静脉注射,3次/d,疗程为1周。比较2组患者治疗前后尿N-乙酰-β-氨基葡萄糖苷酶(NAG)、血肌酐(Scr)、血半胱氨酸蛋白酶抑制剂C(Cys-C)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平,肾损伤发病率及连续性肾脏替代治疗(CRRT)率。结果 UTI组患者在第5、7天的急性肾损伤发病率较对照组显著降低(P<0.05);与对照组比较,UTI组尿NAG、血Cys-C、TNF-α及IL-6浓度在第3、5、7天均显著下降(P<0.05)。除第7天外,UTI组血Scr浓度在第3、5天均显著下降(P<0.05);UTI组肾损伤发病率显著降低(P<0.05),但需CRRT治疗率无显著降低(P>0.05)。结论乌司他丁对显著减少心肺复苏后急性肾损伤的发病率、减轻肾功能损害、保护肾脏具有极其重要的临床意义。

Objective To study the effect of Ulinastatin on acute kidney injury and its mechanisms following cardiopulmonary resuscitation. Methods 120 patients were randomly divided into two groups： UTI group（ n = 60） and control group（ n = 60）. All patients were treated,but UTI group increased Ulinastatin 200000 unit intravenous,3 times / day and treatment for one week. The level of urinary N- acetyl- β- glucosaminidase（ NAG）,serum creatinine（ Scr）,serum cystatin C（ Cys- C）,tumor necrosis factor- α（ TNF- α）,interleukin- 6（ IL- 6）,acute kidney function injury and the rate of CRRT were compared between 2 groups. Results The acute kidney injury incidence of the UTI group was significantly lower than the control group（ P〈0. 05） on 5d and 7d. Compared with the control group,the level of urinary NAG,serum Cys- C,TNF- α and IL- 6 were significantly decreased（ P〈0. 05） on 3d,5d and 7d.The level of serum Cr in UTI group were significantly decreased（ P〈0. 05） on 3d and 5d. The kidney injury incidence in UTI group was significantly lower（ P〈0. 05）,but the rate of CRRT was not significantly lower（ P〉0. 05）. Conclusion Ulinastatin can reduce the incidence of acute kidney injury following cardiopulmonary resuscitation,mitigate kidney functions injury and protect the kidney. It has extremely important clinical significance.