本文選題：烏司他丁 + 肝移植��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:觀察烏司他丁對(duì)親體肝移植患兒腦損傷的影響及機(jī)制研究。方法:擇期因先天性膽道閉鎖行親體肝移植術(shù)患兒60例為研究對(duì)象,年齡6~10月齡,體重6.5~9.5kg,ASA分級(jí)II或III級(jí),肝功能Child-Pugh分級(jí)B~C級(jí),供者平均年齡為33歲(22-50歲),供、受者血型相合,所有患兒全部采用靜吸復(fù)合全身麻醉,手術(shù)方法均采取背馱式肝移植,切取供肝左外葉用于肝移植。按照隨機(jī)數(shù)字表法,隨機(jī)分為兩組(n=30):對(duì)照組(C組)和烏司他丁組(U組)。麻醉誘導(dǎo)后至術(shù)畢,烏司他丁組靜脈輸注烏司他丁10000U/kg,對(duì)照組輸注等劑量0.9%氯化鈉注射液。于麻醉誘導(dǎo)后(T1)、無肝期30分鐘(T2)、新肝期3小時(shí)(T3)及新肝期24小時(shí)(T4)采集中心靜脈血樣,采用ELISA法檢測(cè)患兒血清中S-100β蛋白和神經(jīng)元特異性烯醇化酶(NSE)濃度,采用放射免疫技術(shù)測(cè)定患兒血清中白介素-6(IL-6)、白介素-10(IL-10)及白介素-18(IL-18)的濃度,各時(shí)點(diǎn)記錄心率、平均動(dòng)脈壓、中心靜脈壓和BIS值,采用兒童蘇醒期譫妄評(píng)分量表(Pediatric Anesthesia Emergence Delirium,PAED)和貝利嬰幼兒發(fā)展量表(BSID-Ⅱ),由經(jīng)過培訓(xùn)的醫(yī)師于手術(shù)前1天,術(shù)后第2周對(duì)患兒進(jìn)行神經(jīng)系統(tǒng)評(píng)分,評(píng)價(jià)患兒術(shù)后蘇醒情況和患兒智力及運(yùn)動(dòng)發(fā)展情況,從而得知神經(jīng)系統(tǒng)情況。結(jié)果:2組患兒年齡、手術(shù)時(shí)身體重量、手術(shù)持續(xù)時(shí)間、麻醉持續(xù)時(shí)間、無肝期、輸液量和尿量比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。2組T1時(shí)S-100β濃度和NSE濃度比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。與T1時(shí)比較,2組T2,3時(shí)S-100β濃度和NSE濃度升高(P0.05),T4時(shí)S-100β濃度和NSE濃度比較差異無統(tǒng)計(jì)學(xué)意義(P0.05),與對(duì)照組比較,烏司他丁組T2-4時(shí)血清S-100β蛋白和NSE濃度降低(P0.05),差異具有統(tǒng)計(jì)學(xué)意義。2組T1時(shí)血清IL-6、IL-10及IL-18濃度比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。與對(duì)照組比較,烏司他丁組T2-4時(shí)血清IL-6、IL-18濃度降低,血清IL-10濃度升高(P0.05),差異具有統(tǒng)計(jì)學(xué)意義,與患兒術(shù)前1d比較,兩組患兒術(shù)后2周智力及運(yùn)動(dòng)發(fā)展指數(shù)均降低,與C組比較,患兒運(yùn)動(dòng)發(fā)展指數(shù)(Psychomotor Development Index,PDI)比較無統(tǒng)計(jì)學(xué)意義(P0.05),智力發(fā)展指數(shù)(Mental Development Index,MDI)下降較少(P0.05),PAED評(píng)分降低(P0.05),蘇醒期譫妄評(píng)分降低,具有統(tǒng)計(jì)學(xué)意義。結(jié)論:親體肝移植手術(shù)圍術(shù)期存在腦損傷,于新肝期損傷最為嚴(yán)重,術(shù)后逐漸回落至基礎(chǔ)水平,血清S-100β濃度和NSE水平升高與腦損傷呈正相關(guān),可作為判斷腦損傷的可靠指標(biāo),研究結(jié)果表明,與術(shù)前比較,2組患兒在T2和T3時(shí)血清S-100β蛋白和NSE水平升高,提示親體部分肝移植術(shù)患兒圍術(shù)期發(fā)生了腦損傷,其炎性反應(yīng)是肝臟缺血再灌注誘發(fā)腦損傷的主要病理生理機(jī)制。本研究結(jié)果表明,給予烏司他丁后,患兒T2,3時(shí)血清S-100β蛋白和NSE水平、IL-6和IL-18濃度降低,血清IL-10濃度升高,烏司他丁能在不同程度上抑制腦損傷標(biāo)志物的升高,但不能使其回落至基礎(chǔ)值,分析原因一方面可能與劑量有關(guān);另一方面可能是除炎性反應(yīng)外,還有其他機(jī)制參與肝移植術(shù)誘發(fā)腦損傷。結(jié)合以上結(jié)論,靜脈輸注烏司他丁10000U/kg可減輕親體肝移植術(shù)患兒。
[Abstract]:Objective: To observe the effect and mechanism of ulinastatin on brain injury in children with parent liver transplantation. Methods: 60 children with congenital biliary atresia, aged 6~10 months, weight 6.5~9.5kg, ASA grade II or III, B~C grade of liver function Child-Pugh classification, and the average age of donor 33 years (22-50 years old). All children were treated with combined general anesthesia. All the patients were treated with piggyback liver transplantation and left external leaves used for liver transplantation. According to the random digital table method, two groups (n=30) were randomly divided into the control group (group C) and ulinastatin group (group U). After anesthesia induction to the operation, ulinastatin was injected into Ulinastatin 100. 00U/kg, 0.9% Sodium Chloride Injection in the control group. After anesthesia induction (T1), 30 minutes (T2), 3 hours (T3) in the new liver period and 24 hours in the new liver period (T4), the concentration of S-100 beta protein and neuron specific enolase (NSE) in the serum of the children was detected by ELISA method, and the children were measured by radioimmunoassay. The concentration of interleukin -6 (IL-6), interleukin -10 (IL-10) and interleukin -18 (IL-18) in serum, heart rate, mean arterial pressure, central venous pressure and BIS value at all time points, and the awakening stage of children's delirium scale (Pediatric Anesthesia Emergence Delirium, PAED) and Bailey infant development scale, were used by trained physicians in hand. 1 days before the operation and second weeks after the operation, the children were graded on the nervous system, and the recovery of the children after operation and the intelligence and movement development of the children were evaluated. The results were as follows: the age of the 2 groups, the weight of the body, the duration of the operation, the duration of anesthesia, the anhepatic period, the amount of infusion and the amount of urine, the difference was not statistically significant (P0.05) there was no significant difference in S-100 beta concentration and NSE concentration in group.2 (P0.05). Compared with T1, the concentration of S-100 beta and NSE concentration increased (P0.05) at the 2 groups of T2,3 (P0.05), and there was no significant difference between the concentration of the beta and the concentration in T4. There was no statistically significant difference in serum IL-6, IL-10 and IL-18 concentration in.2 group T1 (P0.05). Compared with the control group, serum IL-6, IL-18 concentration decreased, serum IL-10 concentration increased (P0.05), and the difference was statistically significant when compared with the control group. The difference was statistically significant. The two groups of children were compared with the preoperative 1D, and the two groups of children had 2 weeks of intelligence and motor hair after operation. Compared with the C group, the motor development index (Psychomotor Development Index, PDI) had no statistical significance (P0.05), and the intellectual development index (Mental Development Index, MDI) decreased less (P0.05), PAED score decreased, and the waking period delirium score decreased, with statistical significance. The brain injury was the most serious in the new liver stage, and the level of serum S-100 beta and NSE was positively correlated with brain injury. The results showed that the levels of serum S-100 beta protein and NSE in the 2 groups were increased at T2 and T3, suggesting the parent body. The results of this study showed that serum S-100 beta protein and NSE levels, IL-6 and IL-18 concentrations decreased, serum IL-10 concentration increased, and ulinastatin could be used in different courses after T2,3. The degree of inhibition of the elevation of brain damage markers, but can not make it fall to the basic value, the analysis may be related to the dose related; on the other hand, other mechanisms may be involved in liver transplantation to induce brain damage. Combined with the above conclusion, intravenous infusion of ulinastatin 10000U/kg can reduce the number of children with liver transplantation.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R726.1

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本文編號(hào)：1927001