乌司他丁预先给药对CO_2气腹致腹腔镜妇科手术患者心肌损伤的影响

目的 评价乌司他丁预先给药对CO_2气腹致腹腔镜妇科手术患者心肌损伤的影响.方法 择期腹腔镜下行妇科恶性肿瘤切除术的患者30例,ASA Ⅰ或Ⅱ级,年龄30～60岁,体重50～70 kg,随机分为2组(n=15):对照组(C组)和乌司他丁预先给药组(U组).U组气管插管后30 min内静脉输注乌司他丁1万U/kg,C组以等量生理盐水替代.维持CO_2气腹压力1.3～1.9 kPa.于麻醉诱导前即刻(基础状态)及术后8 h时采集静脉血样,测定血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、谷草转氨酶(AST)和乳酸脱氢酶(LDH)的活性.结果 与基础值比较,C组术后8 h时血清CK和AST的活性升高(P<0.05),血清CK-MB和LDH的活性和U组各指标差异无统计学意义(P>0.05).与C组比较,U组术后8 h时血清CK和AST的活性下降(P<0.05),血清CK-MB和LDH的活性差异无统计学意义(P>0.05).结论 预先静脉输注乌司他丁1万U/kg对腹腔镜妇科手术患者心肌可产生保护作用.

Effect of ulinastatin pretreatment on myocardial injury induced by carbon dioxide pneumoperitoneum in patients undergoing laparoscopic gynecologic surgery

Objective To investigate the effect of ulinastatin pretreatment on the myocardial injury induced by CO_2 pneumoperitoneum in patients undergoing laparoscopic gynecologic surgery. Methods Thirty ASA Ⅰ or Ⅱ patients, aged 30-60 yr, weighing 50-70 kg, scheduled for laparoscopic gynecologic surgery were randomized to 2 groups (n=15 each): control group (group C) and ulinastatin prctreatment group (group U). The patients were premedicated with intramuscular phenobarbital sodium 2 mg/kg and atropine 0.01 mg/kg. Anesthesia was induced with midazolam 0.1 mg/kg, etomidate 0.5 mg/kg, fentanyl 4 μg/kg and rocurenium 0.8 mg/kg. The patients were tracheal intuhated and mechanically ventilated. Group U received iv infusion of ulinastatin 10 000 U/kg over 30 rain following tracheal intubation, while group C equal volume of normal saline instead. The intra-abdominal pressure was maintained at 1.3-1.9 kPa. Anesthesia was maintained with propofol 6 mg·kg~(-1)·h~(-1), remifentanil 0.1 μg ·kg~(-1) min~(-1) , and intermittent injection of vecuronium. Venous blood samples were collected immediately before anesthesia induction (baseline) and 8 h after operation for the measurement of the serum creatine kinase (CK), asparatate aminotransferase (AST), creatine kinase-MB (CK-MB) and lactate dehydrngenase (LDH) activities. Results Compared with the baseline values, the activities of all serum myocardial enzymes did not change significantly 8 h after surgery in group U (P>0.05), while the activities of serum CK and AST were significantly increased in group C (P<0.05). The activities of serum CK and AST were significantly lower in group U than in group C (P<0.05). There were no significant differences in serum CK-MB and LDH activities between two groups (P>0.05). Conclusion Pretreatment with ulinastatin 10 000 U/kg can protect myocardium in patients undergoing laparoscopic gynecologic surgery.