烏司他丁對移植腎保護作用的臨床觀察

[摘要] 目的 比較研究烏司他丁在腎移植術圍術期及術后對腎功能的影響及其對移植腎的保護作用。方法 選擇行腎移植手術患者30例，年齡15-56歲，ASA分級Ⅱ-Ⅲ級。隨機分為烏司他丁組(U組，n=15)和對照組(C組，n=15)，所有患者均采用連續硬膜外麻醉，穿刺間隙L1-2或T12-L1。U組于切皮前和腎血管吻合后將烏司他丁30萬IU加入100ml生理鹽水，快速靜脈點滴。兩組分別于移植腎動脈開放后0.5h、1h、術畢12h抽取靜脈血檢測血漿Cr、BUN，并分別記錄移植腎動脈開放后來尿時間及術后3天尿量。術中常規監測ECG、SPO2、RR、BP。結果2組患者血漿Cr在移植腎動脈開放后0.5h，BUN在移植腎動脈開放后0.5h和1h比較差異無統計學意義(P>0.05);血漿Cr移植腎動脈開放后1h和12h 和 BUN在移植腎動脈開放后12h U組明顯低于C組。移植腎動脈開放后來尿時間U組明顯短于C組(P<0.05)。術后尿量U組明顯多于C組(P<0.05)。結論 應用烏司他丁后能夠顯著降低血漿Cr、BUN水平，縮短移植腎動脈開放后來尿時間，術后尿量增加，有利于移植腎早期功能的恢復。因此，烏司他丁具有確切的腎臟保護作用，應用于臨床腎移植手術是安全有效的。

[關鍵詞] 烏司他丁;移植腎;保護作用

[中圖分類號] R617[文獻標識碼] A[文章編號] 1004-8650(2009)09-112-02

Protective effect of ulinasatin on renal function in renal transplantation

ZHANG Ji-chun 1，ZHANG Yuan-zhou1， MA Yan2， He Ying1， XIE Yu-hui1，JIA Zhi-ping1，MA Su-mei1

(Department of Anesthesiology， PLA 474 hospital，Urumqi 830011， China)

[Abstract] ObjectiveTo evaluate theprotective effect of ulinastatin on renal function in the patients undergion renal transplantion. Methods Thirty patients undergion renal transplation were randomly received either ulinastatin or the same amount of normal saline. The patients in group U received intravenous of ulinastatin 3×105IU in 100ml normal saline before skin incision， subesequently repeated after renal vascular anastomosis. Cr and BUN were measured after transplanted renal artery was opened 0.5， 1 and 12 hours. Recored the times of urine coming after transplanted renal artery was opened and urine volume after surgery.Hemodynamics and oxygen saturation of blood were monitored perioperatively. ResultsCr was same in both group after 0.5 hour transplanted renal artery was opened(P>0.05); but was higher in group U after 1 and 12 hours(P<0.05).BUN was same in both group after 0.5 and 1 hour transplanted renal artery was opened(P>0.05); but was higher in group U after 12 hours(P<0.05).Compared to groups C the tiome of urine coming was significantly shorter in group U(P<0.05)， and the urine volum was also morer in group U(P<0.05).Conclusion Ulinastatin can significantly decrease Cr and BUN、shortened the time of urine coming and increase the urine volum after renal transplantion surgery， so it has a certain protective effect in transplanted renal function in the patients undergoing renal transplantation.

[Key Words] ulinanstatin;transplanted renal;protective function

腎移植已被公認為終末期腎臟替代的較佳選擇，其對患者生活質量的顯著改善是透析治療無法替代的。在圍手術期間，移植腎熱缺血和再灌注損傷是直接影響移植腎的早期功能恢復和遠期存活的主要原因之一。烏司他丁(ulinastatin， UTI)是一種廣譜的酶抑制劑，可明顯減少手術、創傷以及組織器官缺氧引起的多種水解酶和炎性介質造成的機體損傷。……