不同剂量乌司他丁联合肺保护性通气对肝移植手术患者的肺保护作用

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Abstract Objective To explore the effecs of different doses of ulinastatin combined with lung-protecting mechanical ventilation on acute lung injury after orthotopic liver transplantation by observing the changes of plasma markers of lung injury and inflammatory mediators.Methods Sixty patients scheduled for liver transplantation under general anesthesia received different doses of ulinastatin combined with the lung-protecting mechanical ventilation strategy. All the patients were randomly divided into three groups: patients in group A were treated with lung-protecting mechanical ventilation alone, group B in which lung-protecting mechanical ventilation was adopted combined with ulinastatin 50,000 U/kg, and group C which was combined with ulinastatin 100,000 U/kg instead. Blood samples were collected from the radial artery for blood gas results and fluid plasma markers of lung injury while bronchoalveolar lavage fluid (BALF) was collected for inflammatory mediators at the following time points: before operation(T₁), 3 h in the preanhepatic stage (T₂), 2 h (T₃)and 4 h in the neohepatic stage (T₄). Plasma markers of lung injury, which were clara cell secretory protein 16(CC16), surfactant proteins(SP-D) and soluble receptor for advanced glycation end-products (sRAGE), and inflammatory mediators such as TNF-α and IL-8, were monitored. Moreover, the oxygenation index (PaO₂/FiO₂,OI), time of tracheal extubation, length of ICU stay and incidence of acute lung injury within one week were recorded.Results Compared with patients in group A, levels of CC16, SP-D and sRAGE in group B and group C were all lower at T₃, so was CC16 in group C at T₂. In group B, levels of TNF-α at T₂ and T₄ were lower, so were levels of TNF-α in group C from T₂ to T₄ and IL-8 at T₂ and T₄ (P<0.05). Moreover, PaO₂/FiO₂ (OI) was relatively high in group B at T₄, and from T₂ to 2 h after operation in group C, where an earlier tracheal extubation and a shorter ICU stay were observed (P<0.05).Conclusions Ulinastatin(100,000 U/kg) combined with the lung-protecting mechanical ventilation strategy may contribute to the protection of lung function in patients for liver transplantation, which can lead to lower levels of plasma markers of lung injury and inflammatory mediators, a higher OI, earlier tracheal extubation and a shorter stay of ICU.

Key words： acute lung injury plasma marker of lung injury bronchoalveolar lavage fluid inflammatory mediator liver transplantation lung-protecting mechanical ventilation strategy ulinastatin

Received: 20 November 2018

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	DONG Lan
	WANG Naitian
	CHEN Xiaoyang
	LI Zhanjun

Cite this article:

DONG Lan,WANG Naitian,CHEN Xiaoyang等. Effects of different doses of ulinastatin combined with lung-protecting mechanical ventilation on cate lung injury during liver transplantation[J]. Med. J. Chin. Peop. Armed Poli. Forc., 2019, 30(6): 513-517.

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http://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR http://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2019/V30/I6/513

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