可控型心脏死亡后器官捐献术中应用乌司他丁预处理对肾移植受体术后肾功能的影响

doi:10.13481/j.1671-587X.20210228

摘要/Abstract

摘要： 目的

在可控型心脏死亡器官捐献（DCD）术中应用不同剂量的乌司他丁预处理，观察其对肾移植受体术后肾功能的影响。

方法

可控型DCD供体90例，肾移植受体174例。将供体随机分为3组，U1组术中使用乌司他丁5 000 U·kg^－1；U2组术中使用乌司他丁10 000 U·kg^－1；对照组术中不使用乌司他丁，给予等量的生理盐水。检测受体术前及术后1~7 d的血肌酐和血尿素氮水平，计算估算肾小球滤过率（eGFR），记录每小时尿量，计算术后移植物功能延迟恢复（DGF）发生率。

结果

3组受体术后7 d的每小时尿量呈现下降的趋势。术后第1天，U1组和U2组受体每小时尿量高于对照组（P<0.05）。术后第3天，U2组受体每小时尿量高于U1组（P<0.05）。术后第5天，U2组每小时尿量高于U1组（P<0.05）。术后第6天，U2组受体每小时尿量高于U1组和对照组（P<0.05）。其余各天3组受体每小时尿量比较差异无统计学意义（P>0.05）。术后7 d内U1组和U2组受体eGFR均高于对照组，术后第2天U1组受体eGFR高于对照组（P<0.05），其余时间3组受体eGFR比较差异无统计学意义（P>0.05）。3组受体术后7 d内血肌酐水平均明显降低，U1组和U2组受体血肌酐水平较对照组下降幅度更低，但3组间比较差异无统计学意义（P>0.05）。3组受体血尿素氮水平均降低后又升高，U1组和U2组受体血尿素氮水平较对照组下降幅度更大，但3组间比较差异无统计学意义（P>0.05）。对照组、U1组和U2组受体术后DGF发生率分别为10.5%、8.5%和6.9%，U1组和U2组受体术后DGF发生率低于对照组，但3组间比较差异无统计学意义（P>0.05）。

结论

乌司他丁预处理可控型DCD，可促进肾移植受体术后尿量早期恢复，对肾功能有一定的保护作用。

关键词: 乌司他丁, 肾移植, 心脏死亡后器官捐献, 缺血再灌注损伤, 预处理, 肾功能

Abstract: Objective

To investigate the effects of ulinastatin pretreatment in the operation of the controllable donation after cardiac death（DCD） on the postoperative renal function of the recipients.

Methods

A total of 90 cases of controllable DCD donors and 174 cases of renal transplant recipients were selected. The donors were randomly divided into three groups. U1 group： 5 000 U·kg^－1 ulinastatin was used preoperatively； U2 group： 10 000 U·kg^－1 ulinastatin was used preoperatively； control group： no ulinastatin was used preoperatively， instead of an equal volume of normal saline. The levels of serum creatinine and blood urea nitrogen of the recipients before and 1~7 d after operation were detected， the estimated glomerular filtration rate （eGFR） was calculated， the hourly urine volumes were recorded， and the postoperative incidence rates of delayed graft function （DGF） were calculated.

Results

The hourly urine volume showed a decreasing trend in the three groups within 7 d postoperatively. The hourly urine volumes in U1 group and U2 group on the first day after operation were higher than that in control group （P<0.05）； the hourly urine volume of the recipients on the third day after operation in U2 group was higher than that in U1 group （P<0.05）； the hourly urine volume of the recipients on the 5th day after operation in U2 group was higher than that in U1 group （P<0.05）； the hourly urine volume of the recipients on the 6th day after operation in U2 group was higher than those in U1 group and control group （P<0.05）. There were no significant differences in hourly urine volumes among three groups on the other days （P>0.05）. The eGFR of the recipients in U1 group and U2 group were higher than those in control group within 7 d after operation （P<0.05）； the eGFR of the recipientsof the recipients in U1 group was higher than that in control group on the 2nd day after operation （P<0.05）. There were no significant differences in the eGFR among three groups for the rest of time. The serum creatinine levels of the recipients in three groups were significantly decreased； the serum creatinine levels of the recipients in U1 and U2 groups were decreased more greatly than control group， but the differences among three groups were not statistically significant （P>0.05）. The blood urea nitrogen levels of the recipients in three groups were decreased first and then increased， and the blood urea nitrogen levels of the recipients in U1 and U2 groups were decreased more greatly than control group， but the differences among three groups were not statistically significant （P>0.05）. The incidence rates of DGF after operation in control group， U1 group and U2 group were 10.5%， 8.5% and 6.9%， respectively， but the differences among three groups were not statistically significant （P>0.05）.

Conclusion

Ulinastatin pretreatment of controllable DCD can promote the early recovery of urine volume of recipients after renal transplantation and protect the renal function to some extent.

Key words: ulinastatin, renal transplantation, donation after cardiac death, ischemia reperfusion injury, pretreatment, renal function

中图分类号:

R617

宋洋洋,蔺婷婷,何岍妍,刘环秋,冯艳华. 可控型心脏死亡后器官捐献术中应用乌司他丁预处理对肾移植受体术后肾功能的影响[J]. 吉林大学学报(医学版), 2021, 47(2): 469-476.

Yangyang SONG,Tingting LIN,Qianyan HE,Huanqiu LIU,Yanhua FENG. Effect of ulinastatin pretreatment on postoperative recipients’ renal function in operation of donation after controllable cardiac death[J]. Journal of Jilin University(Medicine Edition), 2021, 47(2): 469-476.

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参考文献 20

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Items	Age (year)	Gender [male，n(η/%]	BMI (kg·m^－2)	MAP (P/mmHg)	HR (beat·min^－1)	Na⁺ [c_B/(mmol·L^－1)]
Control	49.53±6.94	22(73.3)	23.56±2.23	99.10±8.31	92.43±8.42	140.65±6.95
U1	46.13±9.16	24(80.0)	24.23±1.99	100.78±9.20	88.33±8.91	141.94±4.23
U2	45.33±11.63	22(73.3)	23.55±1.70	99.54±7.43	89.10±11.38	142.17±10.30
χ²/F	1.675	0.481	1.157	0.326	1.529	0.349
P	0.193	0.786	0.319	0.723	0.222	0.706
Group	Serum creatinine [c_B/ (mmol·L^－1)]	Blood urea nitrogen [c_B/ (mmol·L^－1)]	CPR [Yes，n(η/%)]	Cause of death[n(η/%)]
Group	Serum creatinine [c_B/ (mmol·L^－1)]	Blood urea nitrogen [c_B/ (mmol·L^－1)]	CPR [Yes，n(η/%)]	Trauma	Cerebral hemorrhage	Others
Control	91.50(78.75,101.18)	4.83(3.80,5.86)	2(6.7)	13(43.3)	14(46.7)	3 (10.0)
U1	91.75(65.83,104.68)	3.68(2.98,6.15)	1(3.3)	15(50.0)	12(40.0)	3 (10.0)
U2	86.10(68.00,108.78)	4.19(3.75,7.02)	2(6.7)	14(46.7)	13(43.3)	3 (10.0)
χ²/F	0.339	3.079	—		—
P	0.844	0.214	0.999		0.996

Group	n	Gender [male，n(η/%]	Age (year)	BMI (kg·m^－2)	Warm ischemia time (t/min)	Cold ischemia time (t/h)		Preoperative dialysis (year)		Operation time(t/min)
Control	57	36(63.2)	43.95±9.53	22.79±2.93	3.47±0.69	6.34±3.17		2.5(1.5,4.5)		117.40±16.60
U1	59	37(62.7)	42.08±11.36	22.4±2.76	3.53±0.48	7.12±3.28		2.0(1.0,3.0)		119.68±17.41
U2	58	35(60.3)	45.10±10.76	23.06±2.57	3.34±0.47	7.26±3.26		2.0(1.0,3.0)		117.02±17.01
χ²/F		0.112	1.212	0.821	1.786	1.355		3.378		0.418
P		0.945	0.300	0.442	0.171	0.261		0.185		0.659
group	n	Dialysis methods[n(η/%)]			Renal arterial anastomosis[n(η/%)]
group	n	Peritoneal dialysis	Hemodialysis	No	RA with IIA		RA with EIA		RA with IIA and EIA
Control	57	5(8.8)	50(87.7)	2(3.5)	2(3.5)		55(96.5)		0(0.0)
U1	59	9(15.3)	50(84.7)	0(0.0)	4(6.8)		54(91.5)		1(1.7)
U2	58	10(17.2)	47(81.0)	1(1.7)	5(8.6)		52(89.7)		1(1.7)
χ²/F			—				—
P			0.421				0.705

Group	n	MAP
Group	n	Before anesthesia	After anesthesia	Renal artery opening	End of the surgery
Control	30	111.98±10.83	96.72±7.49	103.91±7.37	102.91±7.41
U1	59	111.12±10.85	96.53±7.96	102.73±7.77	102.79±7.83
U2	58	111.22±10.67	96.26±8.26	103.86±8.03	101.31±13.39
F		0.110	0.049	0.438	0.469
P		0.896	0.952	0.646	0.626

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