乌司他丁对体外循环心脏手术后病人肾功能的影响

Effects of ulinastatin on renal function after cardiopulmonary bypass

目的 观察乌司他丁对体外循环(CPB)心脏手术后病人肾功能的影响。方法 24例择期心脏瓣膜替换术病人随机分成对照组(C组,n=12)和药物组(U组,n=12);药物组术中予乌司他丁(UTI)30万U注入预充液中随机转入体内,术后1—3 d均予UTI 30万U静滴。对照组予等量生理盐水。分别于术前(T0)、术后1 d(T1)、3 d(T3)、5 d(T5)、7 d(T7)检测尿中视黄醇结合蛋白(RBP)、尿中N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、尿中-β2-微球蛋白(β2-MG)、血清β2-MG、血清肌酐(Cr)、血清尿素氮(BUN)。结果 ①尿RBP:C组术后各时点值以及U组T1、T3值明显高于T0值(P<0.01、P<0.05),两组术后各时点值比较,U组明显低于C组(P<0.01);②尿NAG:C组术后各时点值显著高于T0(P<0.01),U组术后各时点值逐渐升高,T5、T7与T0比较差异有显著性(P<0.05、P<0.01),两组间术后各时点值比较差异有显著性(P<0.01);③尿β2-MG:C组术后各时点值显著高于T0值(P<0.01),U组T1、T3明显高于T0值(P<0.05),两组间术后各同一时点值比较差异有显著性(P<0.01);④血β2-MG:C组术后仅T3明显高于T0值及U组同一时点值(P<0.05);⑤BUN、Cr:C组术后仅T1、T3显著高于T0及U组同一时点值(P<0.05)。结论UTI对CPB心脏手术后病人肾脏功能具有保护作用。

Objective To investigate the effects of ulinastatin ( UTI) on renal function after cardiopulmonary bypass (CPB) .Methods Twenty-four NYHA functional capacity class Ⅱ - Ⅲ patients (15 male, 9 female) aged 24-52 yr, weighing 41-75 kg undergoing valve replacement with CPB were randomly divided into two groups :group ulinastatin (group U, n = 12) and group control (group C, n = 12) . Anesthesia was induced with midazolam 0.1 mg · kg-1 , fentanyl 10 55% · kg-1 and vecuronium 0.15 mg · kg-1 and maintained with intermittent iv boluses of fentanyl, midazolam and vecuronium supplemented with isoflurane inhalation. In group U UTI 300 000 U was added to the priming solution and 300 000U/d was infused iv on the first three days after operation. In group C normal saline was given iv instead of UTI. Blood samples were taken and urine was collected before operation (T0), on the 1st (T,), 3rd (T3), 5th (T5) and 7th day (T7) after operation for determination of serum urea nitrogen (BUN), creatinine (Cr), β 2-microglobulin (β 2-MG) and urinary β2-MG, RBP and NAG. Results (1) There were no significant differences between the two groups with respect to age, sex, body weight, CPB time and aortic cross-clamping time. (2) BUN, Cr and serum β 2-MG levels increased significantly after operation at T1 and/or T3 as compared with the baseline values (T0) in group C and were significantly higher than those in group U at the corresponding time points ( P < 0.05) . (3) The urinary β2-MG concentration increased significantly after operation in both groups as compared with the baseline values (T0 ) and was significantly higher in group C than in group U at T1-7 ( P < 0.01) . (4) The urinary NAG and RBP were both increased after operation as compared with baseline values (T0) in both groups and were significantly higher in group C than in group U (P < 0.05, 0.01) .Conclusion Ulnastatin has protective effects on renal function in patients undergoing CPB.