乌司他丁对高龄食管癌患者术后肺肝肾功能的影响

目的 研究乌司他丁对高龄食管癌患者术后肺、肝、肾功能的影响.方法 收集2005年1月至2008年1月第三军医大学西南医院收治的40例高龄食管癌患者的临床资料,按照随机数字表法分为对照组、乌司他丁组.两组患者均于术后给予7 d全胃肠外营养(TPN),其中乌司他丁组同时给予乌司他丁40万U/d静脉滴注.分别于术前及术后第2天、第6天晨抽取两组患者的动、静脉血测量PaO_2、PaCO_2、氧分压/吸入气体氧含量(PaO_2/FiO_2)、ALT、AST、TBil、尿酸、尿素氮、肌酐.采用t检验和χ~2检验分析结果.结果 术后第6天,乌司他丁组和对照组的PaO_2分别为(87.3±4.2)mm ng(1 mm Hg=0.133 kPa)和(79.0±4.3)mm Hg,PaO_2/FiO_2分别为(416±20)mm Hg和(376±20)mm Hg;两组比较差异有统计意义(t=6.2,6.2,P<0.05).乌司他丁组和对照组的ALT分别为(23±7)U/L和(39±8)U/L,AST分别为(38±8)U/L和(50±9)U/L,TBil分别为(13.4±3.0)μmol/L和(24.5±6.0)μmol/L,两组比较差异有统计学意义(t=7.0,4.4,7.6,P<0.05).乌司他丁组和对照组的尿酸分别为(279±84)μmol/L和(386±67)μmol/L,尿素氮分别为(4.1±1.7)mmol/L和(8.9±2.7)mmol/L,肌酐分别为(66±12)μmol/L和(95±38)μmol/L,两组比较差异有统计学意义(t=4.4,6.4,3.3,P<0.05).乌司他丁组并发症发生率低于对照组(χ~2=4.8,P<0.05).结论 在术后常规行TPN治疗的基础上,应用乌司他丁可以更好地保护和改善高龄食管癌患者的肺、肝、肾功能.

Effects of ulinastatin on pulmonary and hepatorenal function of elderly patients undergoing resection of esophageal cancer

Objective To investigate the effects of ulinastatin on pulmonary and hepatorenal function of elderly patients undergoing resection of esophageal cancer. Methods The clinical data of 40 elderly patients with esophageal cancer who had been admitted to Southwest Hospital from January 2005 to January 2008 were retrospectively analyzed. All the patients were randomly divided into control group (n = 20) and ulinastatin group (n = 20) according to random number table. Patients were administered with total parenteral nutrition, and patients in ulinaslatin group were additionally instilled with 4×10~5 U/d of ulinastatin. The levels of PaO_2, PaCO_2, PaO_2/FiO_2, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (Tbil), blood urea nitrogen, creatinine and uric acid were detected preoperatively and at postoperative day 2 and day 6. All the data were analyzed by t-test and chi-square test. Results The levels of PaO_2 and PaO_2/FiO_2 were (87.3±4.2) mm Hg (1 mm Hg =0.133 kPa) and (416±20)mm Hg in ulinastatin group, which were significantly higher than (79.0±4.3)mm Hg and (376±20)mm Hg in control group (t =6.2, 6.2, P <0.05). The levels of ALT, AST and Tbil were (23±7)U/L, (38±8)U/L and (13.4±3.0) μmol/L in ulinastatin group, and (39±8) U/L, (50±9) U/L and (24.5±6.0) μmol/L in control group, with significant difference between the 2 groups (t = 7.0, 4.4, 7.6, P < 0.05). The levels of uric acid, blood urea nitrogen and creatinine were (279±84) μmol/L, (4.1±1.7) mmol/L and (66±12) μmol/L in ulinastatin group, and (386±67)μmol/L, ( 8.9±2.7) mmol/L and (95±38) μmol/L in control group, with significant difference between the 2 groups (t = 4.4, 6.4, 3.3, P < 0.05). The recurrence of complications in ulinastatin group was significantly lower than that in control group (χ~2 = 4.8, P <0.05). Conclusion Postoperative supplementation of ulinastatin and total parenteral nutrition is helpful in improving the pulmonary and hepatorenal function of elderly patients undergoing resection of esophageal cancer.