CAJ | 학술논문

目的探讨乌司他丁对肝移植患者术中血流动力学的保护作用.方法将96例行同种异体非转流原位肝移植的终末期肝病患者分层随机分为两组:乌司他丁组(U组,n=48)和对照组(C组,n=48).观察并分别记录麻醉后、无肝前期(T0)、肝下下腔阻断30 min(T1)、肝下下腔开放30 min(T2)、肝下下腔开放60 min(T3)、肝下下腔开放120 min(T4)和手术结束时(T5)两组患者的心输出量(CCO)、平均动脉血压(MABP)、体循环阻力(SVR)、平均肺动脉压(MPAP)及肺毛细血管嵌压(PAWP)等血流动力学参数.结果两组患者无肝前期CCO、MABP、MPAP、PAWP和右心室射血分数(RVEF)均明显下降(P<0.01),SVR明显升高(P<0.01);开放肝血流后30 min,两组患者MABP和RVEF开始回升,但仍明显低于无肝前期(P<0.01,P<0.05),SVR较无肝前期明显下降;再灌注后60 min,U组患者CCO、MABP和RVEF恢复至无肝前期水平,SVR明显高于无肝前期,MPAP和PAWP基本正常或接近于正常范围.两组比较差异有统计学意义(P<0.05,P<0.01).结论乌司他丁能够改善移植肝脏缺血再灌注综合征,降低血管活性药物的使用量,对原位肝移植患者血流动力学的稳定性具有良好的保护作用.
목적 탐토오사타정대간이식환자술중혈류동역학적보호작용.방법 장96례행동충이체비전류원위간이식적종말기간병환자분층수궤분위량조:오사타정조(U조,n=48)화대조조(C조,n=48).관찰병분별기록마취후、무간전기(T0)、간하하강조단30 min(T1)、간하하강개방30 min(T2)、간하하강개방60 min(T3)、간하하강개방120 min(T4)화수술결속시(T5)량조환자적심수출량(CCO)、평균동맥혈압(MABP)、체순배조력(SVR)、평균폐동맥압(MPAP)급폐모세혈관감압(PAWP)등혈류동역학삼수.결과 량조환자무간전기CCO、MABP、MPAP、PAWP화우심실사혈분수(RVEF)균명현하강(P<0.01),SVR명현승고(P<0.01);개방간혈류후30 min,량조환자MABP화RVEF개시회승,단잉명현저우무간전기(P<0.01,P<0.05),SVR교무간전기명현하강;재관주후60 min,U조환자CCO、MABP화RVEF회복지무간전기수평,SVR명현고우무간전기,MPAP화PAWP기본정상혹접근우정상범위.량조비교차이유통계학의의(P<0.05,P<0.01).결론 오사타정능구개선이식간장결혈재관주종합정,강저혈관활성약물적사용량,대원위간이식환자혈류동역학적은정성구유량호적보호작용.
Objective To explore the protection of ulinastatin on hemodynamics in the patients with liver transplantation. Methods 96 patients with orthotopic liver transplantation without bypass were randomly divided into ulinastatin group (group U, n=48) and control group (group C, n=48). Hemodynamic parameters including CCO, MABP, SVR, MPAP, PAWP and RVEF were recorded at postanesthetic and preanhepatic phase, clamping postcava 30 min, opening postcava 30 min, opening postcava 60 min, opening postcava 120 min and the end of operation respectively. Results The CCO, MABP, MPAP, PAWP and RVEF decreased significantly, the SVR increased obviously at anhepatic phase in two group patients (P<0.01). The MABP and RVEF started to recover at opening postcava 30 min, but still lower than at preanhepatic phase, the SVR decreased obviously compared with anhepatic phase in two groups (P<0.05～0.01). The CCO, MABP, RVEF recovered to the level of preanhepatic phase, the SVR was higher significantly than at preanhepatic phase and MPAP, PAWP were nearly normal at opening postcava 60 min in group U. There were significant differences between the two groups(P<0.05～0.01). Conclusion Ulinastatin can ameliorate ischemia-reperfusion syndrome and reduce the use of vasoactive medicines, which may play an important role in keeping hemodynamic stability.