CAJ | 학술논문

目的评价乌司他丁预先给药对CO_2气腹致腹腔镜妇科手术患者心肌损伤的影响.方法择期腹腔镜下行妇科恶性肿瘤切除术的患者30例,ASA Ⅰ或Ⅱ级,年龄30～60岁,体重50～70 kg,随机分为2组(n=15):对照组(C组)和乌司他丁预先给药组(U组).U组气管插管后30 min内静脉输注乌司他丁1万U/kg,C组以等量生理盐水替代.维持CO_2气腹压力1.3～1.9 kPa.于麻醉诱导前即刻(基础状态)及术后8 h时采集静脉血样,测定血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、谷草转氨酶(AST)和乳酸脱氢酶(LDH)的活性.结果与基础值比较,C组术后8 h时血清CK和AST的活性升高(P<0.05),血清CK-MB和LDH的活性和U组各指标差异无统计学意义(P>0.05).与C组比较,U组术后8 h时血清CK和AST的活性下降(P<0.05),血清CK-MB和LDH的活性差异无统计学意义(P>0.05).结论预先静脉输注乌司他丁1万U/kg对腹腔镜妇科手术患者心肌可产生保护作用.
목적 평개오사타정예선급약대CO_2기복치복강경부과수술환자심기손상적영향.방법 택기복강경하행부과악성종류절제술적환자30례,ASA Ⅰ혹Ⅱ급,년령30～60세,체중50～70 kg,수궤분위2조(n=15):대조조(C조)화오사타정예선급약조(U조).U조기관삽관후30 min내정맥수주오사타정1만U/kg,C조이등량생리염수체대.유지CO_2기복압력1.3～1.9 kPa.우마취유도전즉각(기출상태)급술후8 h시채집정맥혈양,측정혈청기산격매(CK)、기산격매동공매(CK-MB)、곡초전안매(AST)화유산탈경매(LDH)적활성.결과 여기출치비교,C조술후8 h시혈청CK화AST적활성승고(P<0.05),혈청CK-MB화LDH적활성화U조각지표차이무통계학의의(P>0.05).여C조비교,U조술후8 h시혈청CK화AST적활성하강(P<0.05),혈청CK-MB화LDH적활성차이무통계학의의(P>0.05).결론 예선정맥수주오사타정1만U/kg대복강경부과수술환자심기가산생보호작용.
Objective To investigate the effect of ulinastatin pretreatment on the myocardial injury induced by CO_2 pneumoperitoneum in patients undergoing laparoscopic gynecologic surgery. Methods Thirty ASA Ⅰ or Ⅱ patients, aged 30-60 yr, weighing 50-70 kg, scheduled for laparoscopic gynecologic surgery were randomized to 2 groups (n=15 each): control group (group C) and ulinastatin prctreatment group (group U). The patients were premedicated with intramuscular phenobarbital sodium 2 mg/kg and atropine 0.01 mg/kg. Anesthesia was induced with midazolam 0.1 mg/kg, etomidate 0.5 mg/kg, fentanyl 4 μg/kg and rocurenium 0.8 mg/kg. The patients were tracheal intuhated and mechanically ventilated. Group U received iv infusion of ulinastatin 10 000 U/kg over 30 rain following tracheal intubation, while group C equal volume of normal saline instead. The intra-abdominal pressure was maintained at 1.3-1.9 kPa. Anesthesia was maintained with propofol 6 mg·kg~(-1)·h~(-1), remifentanil 0.1 μg ·kg~(-1) min~(-1) , and intermittent injection of vecuronium. Venous blood samples were collected immediately before anesthesia induction (baseline) and 8 h after operation for the measurement of the serum creatine kinase (CK), asparatate aminotransferase (AST), creatine kinase-MB (CK-MB) and lactate dehydrngenase (LDH) activities. Results Compared with the baseline values, the activities of all serum myocardial enzymes did not change significantly 8 h after surgery in group U (P>0.05), while the activities of serum CK and AST were significantly increased in group C (P<0.05). The activities of serum CK and AST were significantly lower in group U than in group C (P<0.05). There were no significant differences in serum CK-MB and LDH activities between two groups (P>0.05). Conclusion Pretreatment with ulinastatin 10 000 U/kg can protect myocardium in patients undergoing laparoscopic gynecologic surgery.