乌司他丁对法洛四联症患者围术期肝、肾功能的保护作用

目的评价乌司他丁对法洛四联症手术患者肝、肾功能的保护作用。方法将38例法洛四联症患者分为乌司他丁组和对照组，每组19例。乌司他丁组患者于术前1h、术后1h和24h静脉滴注乌司他丁，剂量为每次10000U／kg；对照组患者不给予乌司他丁。两组患者于术前、术后1h、10h、24h、48h和72h分别留取10ml新鲜尿液和2ml血液，检测肝肾功能的各项指标。记录每小时进液量、尿量、纵隔、胸腔引流量、呋塞米用量、机械通气和重症监护时间。结果两组患者均未发生各种心律失常和低心排血量综合征，无围术期死亡。乌司他丁组与对照组比较呋塞米用量少、尿量多、机械通气时间短；乌司他丁组尿蛋白和尿酶检测的异常高峰值低于对照组（术后10h，尿微量白蛋白：65．2±58．3mg／Lvs．71．8±58．9mg／L；尿转铁蛋白：5．8±3．6mg／Lvs．7．4±5．4mg／L；尿免疫球蛋白G：26．9±20．3mg／Lvs．31．3±23．3mg／L；术后1h尿NAG：61．4±81．6U／Lvs．76．1±48．5U／L；P〈0．05），异常持续时间短（P〈0．05），术后48h和72h基本接近术前水平。对照组丙氨酸氨基转移酶在术后各时间点均升高（P〈0．01），而乌司他丁组无明显改变（P〉0．05）。乌司他丁组天冬氨酸氨基转移酶（AST）上升程度低于对照组（术后10h 144．4±20．8U／Lvs．202．7±74．1U／L，P〈0．01），术后48h和72h基本接近术前水平。结论对法洛四联症患者围术期使用乌司他丁是保护肝肾功能的有效措施，其临床应用安全、有效。

Protective Effects of Ulinastatin on the Peri-operative Liver and Renal Function in Patients Undergoing Cardiac Surgery for Tetralogy of Fallot

Objective To evaluate the protective effects of Ulinastatin on the peri-operative liver and renal function in patients undergoing cardiac surgery for tetralogy of Fallot（TOF）. Methods Thirty-eight patients with TOF were divided into Ulinastatin group and control group according to admission sequence, 19 cases in each group. For Ulinastatin group, intravenous Ulinastatin was given with a dosage of 10 000U/kg at 1h before operation, 1h and 24 h after operation. For control group, no Ulinastatin was given. 10 ml fresh urine and 2 ml blood samples were collected before operation, and postoperative 1h, 10h, 24h, 48h and 72h, respectively. The liver and renal functions were measured. Fluid intake, urine output, chest drainage, dosage of furosemide, durations of mechanical ventilation and intensive care unit （ICU） stay were recorded. Results Neither arrhythmia nor low cardiac output syndrome occurred for both groups. No peri-operative death. Compared with control group, dose of furosemide, period of mechanical ventilation were lower, while urine output was higher in Ulinastatin group ; the aberrant climax value of urine protein and N-acetylglucosaminidase （NAG） were lower in Ulinastatin group （10h post-operatively,urine microalbumin： 65. 2±58. 3mg/L vs. 71. 8±58. 9mg/L; urine transferrin： 5. 8±3. 6mg/L vs. 7. 4 ± 5. 4mg/L; urine immunoglobulin G ： 26.9 ± 20.3mg/L vs. 31.3 ± 23.3mg/L; 1h post-operatively; urine NAG ： 61.4 ± 81.6U/L vs. 76. 1± 48. 5 U/L; P〈0. 05）and maintained in shorter period （P〈0. 05）, it returned to baseline value at 48h and 72 h post-operatively. The value of alanine aminotransferase （ALT） significantly increased post-operatively at every time points in control group（P〈0.01）, while no obvious change in Ulinastatin group（P〉0.05）. The increased value of aspartate aminotransferase （AST） in Ulinastatin group was significantly lower than that in control group （10h post-operatively： 144.4±20. 8U/L vs. 202.7±74.1U/L; P〈0.01）. The value of