Effects of ullnastatin on proinflammatory cytokines and oxygen free radicals during orthotopic liver transplantation
- VernacularTitle:乌司他丁对原位肝移植术患者围术期促炎性细胞因子和氧自由基代谢的影响
- Author:
Huan ZHANG
;
Qing QIAO
;
Baxian YANG
- Publication Type:Journal Article
- Keywords:
Ulinastatine;
Liver transplantation;
Cytokines;
Oxygen free radicals
- From:
Chinese Journal of Anesthesiology
1994;0(05):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the effects of ulinastatin on proinflamatory cytokines and oxygen free radical during orthotopic liver transplantation (OLT). Methods Eighteen ASA Ⅲ-Ⅳ patients with end-stage liverⅣ diseases, undergoing OLT were randomly divided into two groups: (1) ulinastatin group received intravenous infusion of ulinastatin 2? 105 IU in 100 normal saline after skin incision and every 4 hours thereafter (group U n = 9); control group received same amount of normal saline instead of ulinastatin (group C n = 9). Anesthesia was induced with midazolam 0.1-0.2 mg?kg-1 , fentanyl 5 ?g?kg-1 and pipecuronium 0.1 mg?kg-1 and maintained with isoflurane inhalation and intermittent iv boluses of fentanyl and pipecuronium combined with epidural anesthesia(T8.9). The patients were mechanically ventilated with 100% O2 and PETCO2 was maintained at 35-40 mm Hg during operation. Swan-ganz catheter was inserted via right internal jugular or subclavian vein after induction of anesthesia. Cardiac output, mixed venous oxygen saturation and central venous temperature were continuously monitored with continuous cardiac output monitor (Baxter, Vigilance). ECG,CVP,SpO2 and PETCO2 were also continuously monitored during operation. Radial artery was cannulated for continuous direct blood pressure monitoring. Blood samples were taken before skin incision (T0), 120 min after skin incision (T1), 30 min after liver was removed ( anhepatic phase) (T2) , 5 min and 60 min after reperfusion of the graft (T3 , T4) and at the end of operation (T5 ) for determination of plasma IL-6, IL-8, TNF-? and MDA concentration. Body temperature was maintained above 35.5℃ during operation. Venovenous bypass was performed during anhepatic phase. Results (1) In group C plasma IL-6 and Ⅱ-8 concentrations were significantly increased from T1-5 during operation as compared with the baseline values (T0), whereas plasma levels of TNF-? and MDA did not change significantly before and during anhepatic phase (T1 , 2) but were significantly increased during neohepatic phase and at the end of surgery (T3 ,45) as compared with the baseline values (T0).(2) In group U plasma IL-6, IL-8, TNF-? and MDA concentrations were not significantly increased during operation, except that plasma IL-6 and IL-8 concentrations were significantly higher at T3 (5 min after reperfusion of the graft) than the baseline values. Conclusion Ulinastatin inhibits release of proinflammatory cytokines and reduces production of oxygen free radicals during OLT.
