乌司他丁对异位妊娠出血性休克患者微循环和肾功能的影响

目的：探讨乌司他丁（UTI）对异位妊娠内出血休克患者微循环的改善作用，以及对肾功能的影响。方法：56例异位妊娠内出血休克患者随机分为UTI组和对照组，两组均予补液扩容、输血抗休克、急诊手术治疗，UTI组在术中、术后还给予UTI治疗。结果：术前两组患者TXB2／6-keto-PgFlot比值及血BUN、Scr及尿NAG、γ--GTP基本一致（P均〉0．05）。术后3h及术后6h，U11组TXB2／6-keto-PgF1α比值均明显低于对照组（P〈0．05或〈0．01）；术后12h两组TXB2／6-keto-PgFlot比值才基本一致（P〉0．05）。术后两组患者血BUN、Scr及尿NAG、γ-GTP均较术前明显升高（P〈0．05或〈0．01）；但UTI组升高幅度低于对照组（P〈0．05或〈0．01），术后恢复速度快于对照组（P〈0．05）。结论：UTI对异位妊娠内出血休克患者的肾小球滤过功能和肾小管分泌功能都有一定的保护作用，调节患者血循环中TXA2／PGI2的比值，改善肾脏的微循环血流灌注，可能是UTI对肾功能发挥保护作用的重要机制之一。

Effect of Ulinastatin on Microcirculation and Renal Funtion in Patients Suffering from Hemorrhagic Shock Caused by Ectopic Pregnancy

Objective： To investigate the ameliorating effect of ulinastatin （UTI） on microcirculation and renal function, in patients suffering from hemorrhagic shock caused by ectopic pregnancy. Method： A total of 56 cases suffering from hemorrhagic shock caused by ectopic pregnancy were randomly assigned into the UTI group and controlled group, both of which were treated with volume expansion of fluid infusion, blood transfusion and antishock and emergency surgery. The UTI group was treated with UTI intraoperatively and postoperatively. Result ：The preoperative ratio of TXB2 to 6-keto-PGF1α, the amount of blood urea nitrogen （BUN） and serum creatinine （Scr）, and the urine level of N-aeetyl-13-D-glucosaminidase （NAG） and γ-glutamyl transpeptidase （γ-GTP） were basically consistent between the two groups （both P 〉 O. 05 ）. At postoperative 3 h and 6 h, the ratio of TXB2 to 6-keto-PGF1α in the UTI group was significantly lower than that in the controlled group （ P 〈 0.05 or P 〈 0.01 ） ; at postoperative 12 h, the ratio of TXB2 to 6-keto-PGF1α was basically consistent between the two groups （P 〉 0.05）. However, the postoperative amount of BUN and Scr as well as the urine level of NAG and γ-GTP in the two groups were more obviously increased than those before the operation （P 〈 0.05 or P 〈 0.01 ） ; the increment was lower in the UTI group than in the controlled group （P 〈0.05 or P 〈 0.01 ） and the velocity of the postoperative recovery was faster in the UTI group than in the controlled group （P 〈 0.05）. Conclusion： UTI had a certain protective effect on glomerular filtration and renal tubular secretion in patients suffering from hemorrhagic shock caused by ectopic pregnancy. It could regulate the ratio of TXA2/PGI2 in blood circulation of patients and improve blood flow perfusion in renal microcirculation, which might be one of the important protective mechanisms of UTI on renal function.