【摘要】 目的探讨大剂量乌司他丁治疗对肝内胆管结石患者术后肝肾功能及炎症因子的影响。方法回顾性分析2014年11月至2016年7月在中山大学附属第三医院行肝切除术的41例肝内胆管结石患者临床资料。患者均签署知情同意书,符合医学伦理学规定。根据围手术期是否采用大剂量乌司他丁治疗,将患者分为乌司他丁组和对照组。其中乌司他丁组23例,男12例,女11例;平均年龄(52±10)岁;对照组18例,男8例,女10例;年龄(50±9)岁。乌司他丁组患者术前1 d至术后7 d连续静脉注射大剂量乌司他丁治疗,对照组患者未采用乌司他丁抗炎治疗。观察两组患者围手术期肝肾功能、炎症因子变化。两组检测数据比较采用t检验。结果乌司他丁组术后1、3 d AST、ALT、TB、Scr、BUN水平明显低于对照组(t=-2.03,-2.40,-2.08,-2.09,-2.21和-2.06,-2.12,-2.08,-2.11,-2.59;P<0.05);ALB水平明显高于对照组(t=2.11和2.48;P<0.05)。乌司他丁组术后7 d ALT、TB、Scr明显低于对照组(t=-2.56,-2.41,-2.35;P<0.05)。乌司他丁组术后1、3、7 d IL-6和TNF-α水平明显低于对照组(t=-2.05,-2.39和-2.69,-2.70和-2.45,-2.62;P<0.05);IL-10明显高于对照组(t=2.41,2.67,2.54;P<0.05)。结论大剂量乌司他丁治疗可有效保护肝内胆管结石患者术后肝肾功能,控制机体炎症反应,促进患者术后康复。更多还原

【Abstract】 Objective To investigate the impacts of high-dose ulinastatin on the postoperative hepatic, renal function and inflammatory factors in patients with intrahepatic bile duct stones. MethodsClinical data of 41 patients with intrahepatic bile duct stones who underwent hepatectomy at the Third Affiliated Hospital of Sun Yat-sen University from November 2014 to July 2016 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Patients were divided into the ulinastatin group(n=23) and control group(n=18) according to whether high-dose ulinastatin was administered during the perioperative period. In ulinastatin group, 12 patients were males and 11 were females, aged(52±10) years on average. In control group, 8 patients were males and 10 were females, aged(50±9) years on average. Patients in ulinastatin group received continuous intravenous administration of high-dose ulinastatin from 1 d before surgery to 7 d after surgery, whereas those in control group did not receive ulinastatin anti-inflammatory treatment. Perioperative hepatic, renal function and level of inflammatory factors were observed in both groups. Clinical data were compared between two groups using t test. Results In ulinastatin group, the levels of AST, ALT, TB, Scr, and BUN on the 1 st and 3 rd day after operation were significantly lower than those in control group(t=-2.03,-2.40,-2.08,-2.09,-2.21 and -2.06,-2.12,-2.08,-2.11,-2.59; P<0.05), whereas the levels of ALB were significantly higher than those in control group(t=2.11 and 2.48; P<0.05). At postoperative 7 d, the levels of ALT, TB and Scr in ulinastatin group were significantly lower than those in control group(t=-2.56,-2.41,-2.35; P<0.05). At postoperative 1, 3, and 7 d, the levels of IL-6 and TNF-α in ulinastatin group were significantly lower than those in control group(t=-2.05,-2.39 and -2.69,-2.70 and -2.45,-2.62; P<0.05), whereas the levels of IL-10 were significantly higher than those in control group(t=2.41, 2.67, 2.54; P<0.05). Conclusions High-dose ulinastatin can effectively protect the hepatic and renal function, control the inflammatory response and promote the postoperative recovery of patients with intrahepatic bile duct stones.更多还原