CAJ | 학술논문

目的观察乌司他丁对二尖瓣置换术患者肺和肾脏的保护作用.方法 60例二尖瓣置换术患者,随机分为实验组(30例,乌司他丁组,10000IU/kg)和对照组(30例,生理盐水组).在麻醉诱导后(T1)、开放升主动脉后不同时点(T2～T9)分别监测动脉血气指标和肾功能进行分析.结果开放升主动脉后,对照组的血氧分压(PaO2)均低于实验组(P＜0.05)；对照组呼吸指数上升(P＜0.01),且于3个时点明显高于实验组(0.560±0.079比0.485±0.094,0.592±0.078比0.475±0.085,0.537±0.078比0.430±0.083,P＜0.05).对照组氧合指数(PaO2/FiO2)均低于术前水平(P＜0.01,最低达173.1±23.7),而且明显低于实验组(P＜0.01,173.1±23.7比278.9±22.4).实验组血浆乳酸(Lac)均明显低于对照组(P＜0.05).术后对照组尿素氮(BUN)、肌酐(Cr)呈上升趋势(P＜0.05),而实验组与术前比较差异无统计学意义(P＞0.05).结论在二尖瓣置换术中应用乌司他丁对患者的肺、肾功能具有显著的保护作用,还可以降低血乳酸浓度、改善乳酸代谢.
목적 관찰오사타정대이첨판치환술환자폐화신장적보호작용.방법 60례이첨판치환술환자,수궤분위실험조(30례,오사타정조,10000IU/kg)화대조조(30례,생리염수조).재마취유도후(T1)、개방승주동맥후불동시점(T2～T9)분별감측동맥혈기지표화신공능진행분석.결과 개방승주동맥후,대조조적혈양분압(PaO2)균저우실험조(P＜0.05)；대조조호흡지수상승(P＜0.01),차우3개시점명현고우실험조(0.560±0.079비0.485±0.094,0.592±0.078비0.475±0.085,0.537±0.078비0.430±0.083,P＜0.05).대조조양합지수(PaO2/FiO2)균저우술전수평(P＜0.01,최저체173.1±23.7),이차명현저우실험조(P＜0.01,173.1±23.7비278.9±22.4).실험조혈장유산(Lac)균명현저우대조조(P＜0.05).술후대조조뇨소담(BUN)、기항(Cr)정상승추세(P＜0.05),이실험조여술전비교차이무통계학의의(P＞0.05).결론 재이첨판치환술중응용오사타정대환자적폐、신공능구유현저적보호작용,환가이강저혈유산농도、개선유산대사.
Objective To explore the protective effect of Ulinastatin on lung and kidney for patients with mitral valve replacement (MVR).Methods 60 patients who received MVR surgery were randomly divided into two groups:treatment group (T group,30 cases,ulinastatin,10 000 IU/kg) and control group (C group,30 cases,saline).The data about arterial blood gas analysis and renal function were recorded and analyzed after induction of anesthesia ( T1 ) and at different time points after releasing of aortic cross-clamping (T2-T9).Results After releasing of aortic cross-clamping,PaO2 in C group were significantly lower than in T group ( P ＜ 0.05 ).RI in C group were significantly increased ( P ＜ 0.01 ),while there were no significant changes in T group ( P ＞ 0.05 ) ; RI in C group were significantly higher than in T group (0.560 ± 0.079 vs 0.485 ± 0.094,0.592 ± 0.078 vs 0.475 ± 0.085,0.537 ± 0.078 vs 0.430 ± 0.083,P＜0.05).The level of PaO2/FiO2 C group were significantly lower than the preoperative level ( P ＜ 0.01 ),which were significantly lower than in T group ( P ＜ 0.01 ) ; Lac in T group were significantly lower than C group (P ＜0.05).Compared with preoperative,blood urea nitrogen (BUN) and creatinine (Cr) were higher in C group ( P ＜ 0.05 ),but T group,there were no significantly difference ( P ＞ 0.05 ).Conclusion The experiment proved that the application of ulinastatin in mitral valve replacement has a significant protective effect on lung and renal functions,it also can lower blood lactate concentration,improved lactate metabolism.