CAJ | 학술논문

目的评价乌司他丁对体外循环心内直视手术婴儿围术期肾功能的影响.方法择期拟行心内直视手术的室间隔缺损伴肺动脉高压婴儿40例,月龄3～5月,体重5.3～6.8kg,ASA分级Ⅱ级,性别不限.随机分为2组(n=20):对照组(C组)和乌司他丁组(U组).U组将乌司他丁20 000 U/kg溶于20 ml生理盐水中,颈内静脉注射1/3量,体外循环开始时和主动脉开放即刻预充液中各充入1/3量;C组用生理盐水替代.分别于切皮前30 min(T1)、主动脉阻断前5 min(T2)、主动脉开放后5 min(T3)、术毕(T4)、术后24 h(T5)和48 h(T6)时,留取新鲜尿液,并采集颈内静脉血样,测定尿β2-微球蛋白(β2-MG)浓度和N-乙酞-β-D-葡萄糖苷酶(NAG)活性、血清Cr和BUN的浓度.结果两组血清BUN和Cr浓度组内和组间比较差异无统计学意义(P＞0.05).与T1时比较,两组T2-6时尿NAG活性和β2-MG浓度升高(P＜0.05);与C组比较,U组T3-5时尿NAG活性和β2-MG浓度降低(P＜0.05).结论乌司他丁可保护体外循环心内直视手术婴儿围术期的肾功能.
목적 평개오사타정대체외순배심내직시수술영인위술기신공능적영향.방법 택기의행심내직시수술적실간격결손반폐동맥고압영인40례,월령3～5월,체중5.3～6.8kg,ASA분급Ⅱ급,성별불한.수궤분위2조(n=20):대조조(C조)화오사타정조(U조).U조장오사타정20 000 U/kg용우20 ml생리염수중,경내정맥주사1/3량,체외순배개시시화주동맥개방즉각예충액중각충입1/3량;C조용생리염수체대.분별우절피전30 min(T1)、주동맥조단전5 min(T2)、주동맥개방후5 min(T3)、술필(T4)、술후24 h(T5)화48 h(T6)시,류취신선뇨액,병채집경내정맥혈양,측정뇨β2-미구단백(β2-MG)농도화N-을태-β-D-포도당감매(NAG)활성、혈청Cr화BUN적농도.결과 량조혈청BUN화Cr농도조내화조간비교차이무통계학의의(P＞0.05).여T1시비교,량조T2-6시뇨NAG활성화β2-MG농도승고(P＜0.05);여C조비교,U조T3-5시뇨NAG활성화β2-MG농도강저(P＜0.05).결론 오사타정가보호체외순배심내직시수술영인위술기적신공능.
Objective To investigate the effect of ulinastatin on the renal function during perioperative period in infants undergoing open heart surgery under CPB.Methods Forty ASA Ⅱ infants (25 male, 15 female)aged 3-5 months weighing 5.3-6.8 kg undergoing open heart surgery under CPB were randomly divided into 2 groups (n = 20 each): control group (group C) and ulinastatin group (group U). Ulinastatin 20 000 U/kg in normal saline 20 ml was infused iv in 3 parts (1/3 was infused via CVP line when the catheter was successfully placed in the internal jugular vein; 1/3 at the beginning of CPB and 1/3 at aortic unclamping). Blood and urine samples were collected at 30 min before incision ( T1 ), 5 min before aortic clamping (T2 ), 5 min after aortic unclamping (T3 ), at the end of operation (T4) and 24 and 48 h after operation (T5, T6 ) for determination of serum urea nitrogen (BUN) and creatinine (Cr) and urinary N-acetyl-β-D-glucosaminidase (NAG) and β2-microglubin (β2-MG) levels. Results There was no significant difference in serum BUN and Cr concentrations between the two groups. The urinary β2-MG concentration and NAG activity were significantly increased at T2-6 as compared with baseline values at T1 in both groups. The urinary β2-MG concentration and NAG activity were significantly lower in group U than in group C at T3-5 . Conclusion Ulinastatin can protect the renal function during perioperative period in infants undergoing open heart surgery under CPB.