乌司他丁对老年急腹症手术患者肝肾功能保护的疗效分析

目的 研究乌司他丁对老年急腹症手术患者肝肾功能的影响.方法 将40例老年急腹症患者随机分为乌司他丁组20例及对照组20例.两组均给予常规治疗,乌司他丁组在常规治疗的基础上给予乌司他丁20万U加5%葡萄糖液250 ml或0.9%氯化钠注射液250 ml中,每日静脉滴注2次,疗程为6 d.分别于治疗前1天,治疗后第1、3、5天检测患者血浆中的丙氨酸氨基转移酶(ALT)、白蛋白(ALB)、总胆红素(TBiL)、血肌酐(Scr)、尿素氮(BUN)、肿瘤坏死因子(TNF-a)、白介素-6(IL-6)、白介素-8(IL-8)等指标的变化.结果 术后第1天乌司他丁组的ALT、TBiL和Scr与对照组比较,差异有统计学意义(t分别=2.24、2.02、2.37,P均＜0.05),术后第3天乌司他丁组的ALT、ALB和BUN与对照组比较,差异有统计学意义(t分别=2.85、2.47、2.57,P均＜0.05),术后第5天乌司他丁组的ALT、ALB、Scr和BUN与对照组比较,差异有统计学意义(t分别=3.31、2.39、2.82、2.86,P均＜0.05).术后第1、3、5天乌司他丁组TNF-a低于对照组,IL-6在术后第1、3天、IL-8水平在术后第3、5天均低于对照组,差异有统计学意义(t分别=2.57、2.83、3.02、2.92、2.97、2.87、2.99,P均< 0.05).乌司他丁组的并发症发生率和住院时间亦低于对照组,差异有统计学意义(χ2=4.12,t=3.65,P均＜0.05).结论 乌司他丁对患者术后的肝肾功能有良好的保护作用,其效果显著优于常规药物.

Protective effects of ulinastatin on postoperative liver and renal function in elderly patients with acute abdomen

Objective To investigate the ulinastatin＇s protective effects on postoperative liver and renal function in elderly patients with acute abdomen.Methods Forty elderly patients with acute abdomen were randomly divided into 2 groups：ulinastatin group and control group.Both groups were both given conventional therapy.In ulinastatin group,the patients were subjected to the intravenous drip of 5% dextroglucose or normal saline（250 ml） plus ulinastatin（200,000U） twice daily on the postoperative day 1～6 on the basis of conventional therapy,and those in control group only received 5% dextroglucose or normal saline（250 ml）.The measurement of the plasma alanine aminotransferase（ALT）,albumin（ALB）,total bilirubin（TBiL）,serum creatinine（Scr）,urea nitrogen（BUN）,tumor necrosis factor（TNF-a）,interleukin-6（IL-6）,interleukin-8（IL-8）and other indicators of change was determined on the day before treatment and 1,3,5 days after treatment.Results The levels of ALT,TbiL and Scr in the ulinastatin group and control group had statistic differences on the first postoperation day（t=2.24,2.02,2.37,P0.05）.On the third postoperation day,the levels of ALT,ALB and BUN in the ulinastatin group and control group had statistical differences（t =2.85,2.47,2.57,P 0.05）.On the fifth postoperative day,the levels of ALT,ALB,Scr and BUN in the ulinastatin group and control group had statistic differences（t=3.31,2.39,2.82 2.86,P0.05）.In the ulinastatin group,the level of TNF-a was lower than that in the control group on the first,third,fifth postoperative day,the level of IL-6 on the first,third postoperative day and the level of IL-8 on the third,fifth postoperative day were all lower than those in the control group and had significant differences（t =2.57,2.83,3.02,2.92,2.97,2.87,2.99,P 0.05）.The incidence rate of complication and the hospital stay in the ulinastatin group were both lower than those in the control group with statistic difference（χ2=4.12,t =3.65,P 0.05）.Conclusions Ulinastatin has better protective effects than routine drugs on postoperative liver and renal function in the elderly patients with acute abdomen.