中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2014年
18期
3219-3224
,共6页
吕海金%魏绪霞%安玉玲%易小猛%刘剑戎%熊亮%易慧敏
呂海金%魏緒霞%安玉玲%易小猛%劉劍戎%熊亮%易慧敏
려해금%위서하%안옥령%역소맹%류검융%웅량%역혜민
肝移植%乌司他丁%器官保护
肝移植%烏司他丁%器官保護
간이식%오사타정%기관보호
Liver transplantation%Ulinastatin%Organ protection
目的：比较不同剂量蛋白酶抑制剂乌司他丁对高危肝移植手术患者术后的器官保护作用。方法回顾性队列分析2003年1月至2014年7月在中山大学附属第三医院器官移植中心146例术中失血量3000 ml以上的肝移植患者的临床资料。所有患者均签署知情同意书，治疗符合医学伦理学规定。根据术后静脉使用乌司他丁剂量将上述高危患者分为大剂量组（HD组：400 kU，q6 h）和常规剂量组（RD组：400 kU，q12 h）。HD组63例，术中失血量（5.0±2.9）L，术后当天APACHEⅡ评分20.9±7.5、SOFA评分15.0±3.2；RD组83例，术中失血量（6.2±4.5）L，术后当天APACHEⅡ评分20.0±7.4、SOFA评分14.6±3.4。观察静脉应用乌司他丁5 d治疗后第3、7天APACHEⅡ评分和SOFA评分改变。同时了解两组患者感染发生率、机械通气时间、ICU停留时间、肾替代治疗比例以及90 d生存曲线。连续性资料如符合正态分布采用t检验，非正态分布采用非参数检验；分类资料率的比较采用χ2检验。结果两组患者年龄、性别、术前MELD评分、CTP评分、术中失血量、输血量、手术时间、无肝期时间、术后当天APACHEⅡ和SOFA评分无统计学差异。静脉应用5 d乌司他丁后，未观察到有不良反应发生。虽然两组术后90 d生存曲线无统计学差异（χ2＝0.566， P＝0.452），但HD组第3天和第7天的APACHEⅡ评分、第7天的SOFA评分改善更为明显（5.6±4.5 vs.3.6±3.4，t＝-2.910，P＝0.004；8.5±4.7 vs.4.5±3.9，t＝-5.468，P＜0.001；4.7±3.2 vs.3.2±2.8， t＝-2.944，P＝0.004）；RD/HD感染发生率（39.6%vs.23.8%，OR 2.11，95%CI 1.02～4.37，χ2＝4.129，P＝0.042）、肾替代治疗比例（22.9%vs.9.5%，OR 2.82，95%CI 1.05～7.55，χ2＝4.51，P＝0.034）、机械通气时间（Z＝-5.112，P＜0.01）、ICU停留时间（Z＝-2.604，P＜0.01）较RD组均有统计学差异。结论大剂量乌司他丁能显著改善高危肝移植术后患者多器官功能。
目的：比較不同劑量蛋白酶抑製劑烏司他丁對高危肝移植手術患者術後的器官保護作用。方法迴顧性隊列分析2003年1月至2014年7月在中山大學附屬第三醫院器官移植中心146例術中失血量3000 ml以上的肝移植患者的臨床資料。所有患者均籤署知情同意書，治療符閤醫學倫理學規定。根據術後靜脈使用烏司他丁劑量將上述高危患者分為大劑量組（HD組：400 kU，q6 h）和常規劑量組（RD組：400 kU，q12 h）。HD組63例，術中失血量（5.0±2.9）L，術後噹天APACHEⅡ評分20.9±7.5、SOFA評分15.0±3.2；RD組83例，術中失血量（6.2±4.5）L，術後噹天APACHEⅡ評分20.0±7.4、SOFA評分14.6±3.4。觀察靜脈應用烏司他丁5 d治療後第3、7天APACHEⅡ評分和SOFA評分改變。同時瞭解兩組患者感染髮生率、機械通氣時間、ICU停留時間、腎替代治療比例以及90 d生存麯線。連續性資料如符閤正態分佈採用t檢驗，非正態分佈採用非參數檢驗；分類資料率的比較採用χ2檢驗。結果兩組患者年齡、性彆、術前MELD評分、CTP評分、術中失血量、輸血量、手術時間、無肝期時間、術後噹天APACHEⅡ和SOFA評分無統計學差異。靜脈應用5 d烏司他丁後，未觀察到有不良反應髮生。雖然兩組術後90 d生存麯線無統計學差異（χ2＝0.566， P＝0.452），但HD組第3天和第7天的APACHEⅡ評分、第7天的SOFA評分改善更為明顯（5.6±4.5 vs.3.6±3.4，t＝-2.910，P＝0.004；8.5±4.7 vs.4.5±3.9，t＝-5.468，P＜0.001；4.7±3.2 vs.3.2±2.8， t＝-2.944，P＝0.004）；RD/HD感染髮生率（39.6%vs.23.8%，OR 2.11，95%CI 1.02～4.37，χ2＝4.129，P＝0.042）、腎替代治療比例（22.9%vs.9.5%，OR 2.82，95%CI 1.05～7.55，χ2＝4.51，P＝0.034）、機械通氣時間（Z＝-5.112，P＜0.01）、ICU停留時間（Z＝-2.604，P＜0.01）較RD組均有統計學差異。結論大劑量烏司他丁能顯著改善高危肝移植術後患者多器官功能。
목적：비교불동제량단백매억제제오사타정대고위간이식수술환자술후적기관보호작용。방법회고성대렬분석2003년1월지2014년7월재중산대학부속제삼의원기관이식중심146례술중실혈량3000 ml이상적간이식환자적림상자료。소유환자균첨서지정동의서，치료부합의학윤리학규정。근거술후정맥사용오사타정제량장상술고위환자분위대제량조（HD조：400 kU，q6 h）화상규제량조（RD조：400 kU，q12 h）。HD조63례，술중실혈량（5.0±2.9）L，술후당천APACHEⅡ평분20.9±7.5、SOFA평분15.0±3.2；RD조83례，술중실혈량（6.2±4.5）L，술후당천APACHEⅡ평분20.0±7.4、SOFA평분14.6±3.4。관찰정맥응용오사타정5 d치료후제3、7천APACHEⅡ평분화SOFA평분개변。동시료해량조환자감염발생솔、궤계통기시간、ICU정류시간、신체대치료비례이급90 d생존곡선。련속성자료여부합정태분포채용t검험，비정태분포채용비삼수검험；분류자료솔적비교채용χ2검험。결과량조환자년령、성별、술전MELD평분、CTP평분、술중실혈량、수혈량、수술시간、무간기시간、술후당천APACHEⅡ화SOFA평분무통계학차이。정맥응용5 d오사타정후，미관찰도유불량반응발생。수연량조술후90 d생존곡선무통계학차이（χ2＝0.566， P＝0.452），단HD조제3천화제7천적APACHEⅡ평분、제7천적SOFA평분개선경위명현（5.6±4.5 vs.3.6±3.4，t＝-2.910，P＝0.004；8.5±4.7 vs.4.5±3.9，t＝-5.468，P＜0.001；4.7±3.2 vs.3.2±2.8， t＝-2.944，P＝0.004）；RD/HD감염발생솔（39.6%vs.23.8%，OR 2.11，95%CI 1.02～4.37，χ2＝4.129，P＝0.042）、신체대치료비례（22.9%vs.9.5%，OR 2.82，95%CI 1.05～7.55，χ2＝4.51，P＝0.034）、궤계통기시간（Z＝-5.112，P＜0.01）、ICU정류시간（Z＝-2.604，P＜0.01）교RD조균유통계학차이。결론대제량오사타정능현저개선고위간이식술후환자다기관공능。
Objective To explore whether early use of the increased dose of intravenous ulinastatin improves outcomes in the liver transplant recipients. Methods The cohort study was conducted to investigate clinical data of 146 liver transplant recipients who suffered at least 3 000 ml blood lost during operation performed in the transplantation center of 3rd affiliated hospital, Sun Yat-Sen University. All cases were complied with requirements of medical ethic rules and signed informed consent. A total of 83 patients were treated with intravenous Ulinastatin on a daily dose 400 kU, iv drip, q6 h were assigned to the High-dose group (HD) or the exposure group; the other 63 patients were assigned to the Routine dose group (RD) or the control group with a daily dose of 400 kU, iv drip, q12 h. Any case should be treated with Ulinastatin at least 5 days. Raw data were collected to calculate the APACHEⅡand SOFA score 3 days and 7 days after transplantation. APACHEⅡ,SOFA score and the score changes (ΔA,ΔS), morbidity of sepsis and renal replacement therapy, duration of ventilation and ICU-stay, mortality and the survive curve differences were measured. Results There were no differences between the two groups of the base line characteristics likes the demographic data, MELD and CTP score, operative blood lost and transfusion, anhepatic time, operation duration and the immediate APACHEⅡ, SOFA score (P>0.05). None of any relevant side-effect occurred during therapies. On the 3rd and 7th post-transplant day, the APACHEⅡ decreased more sharply in HD group versus RD group (t=-2.910, P=0.004; t=-5.468, P<0.001); SOFA decreased more in HD group on the 7th post-transplant day (t=-2.944, P=0.004). Morbidity like sepsis and renal failure with necessary renal replacement therapy were significantly lower in the HD group (39.6% vs. 23.8%, OR 2.11, 95% CI 1.02-4.37,χ2=4.129, P=0.042; 22.9% vs. 9.5%, OR 2.82, 95%CI 1.05-7.55,χ2=4.51, P=0.034);Duration of ventilation and ICU stay were much less in HD group with a statistical significance. There was a trend of mortality reduction, although without significant difference of the survival curve between two groups. Conclusion Increased dose of the Ulinastatin is safe and improves the clinical outcomes better than the routine dose.
