Nishiyama Tomoki, Yokoyama Takeshi, Yamashita Koichi
Department of Anesthesiology, The University of Tokyo, Tokyo, Japan.
J Anesth. 2006;20(3):179-82. doi: 10.1007/s00540-006-0396-7.
Ulinastatin is well known to inhibit the activity of polymorphonuclear leukocyte elastase (PMNE). The PMNE concentration correlates with the activities of coagulation and fibrinolysis. The purpose of the present study was to investigate the effects of ulinastatin, a protease inhibitor, on coagulation and fibrinolysis in abdominal surgery.
Thirty patients, aged 40 to 70 years, with American Society of Anesthesiologists (ASA) physical status I or II, scheduled for major abdominal surgery, were enrolled. Anesthesia was induced with midazolam and thiopental, and was maintained with sevoflurane, nitrous oxide in oxygen, and an epidural block. An infusion of ulinastatin, 6000 units x kg(-1) in 30 min, was started 1 h after the start of surgery in the ulinastatin group (15 patients). In the control group (15 patients), no protease inhibitors were infused. White blood cell count; platelet count; prothrombin time; activated partial thromboplastin time; and plasma concentrations of PMNE, antithrombin (AT), fibrin/fibrinogen degradation product (FDP), fibrinogen, plasminogen, plasmin-(alpha2) plasmin inhibitor complex (PIC), and thrombin-antithrombin complex (TAT) were measured before, at the end of, and 12 h after surgery.
TAT, PIC, and FDP after surgery were significantly lower in the ulinastatin group than in the control group. AT was decreased in the control group but not in the ulinastatin group, with significant differences between the two groups.
Ulinastatin could inhibit coagulation and fibrinolysis in abdominal surgery.
已知乌司他丁可抑制多形核白细胞弹性蛋白酶（PMNE）的活性。PMNE浓度与凝血和纤溶活性相关。本研究旨在探讨蛋白酶抑制剂乌司他丁对腹部手术中凝血和纤溶的影响。
纳入30例年龄在40至70岁之间、美国麻醉医师协会（ASA）身体状况为I或II级、计划进行腹部大手术的患者。麻醉诱导采用咪达唑仑和硫喷妥钠，维持采用七氟醚、氧化亚氮和氧气以及硬膜外阻滞。乌司他丁组（15例患者）在手术开始1小时后开始输注乌司他丁，30分钟内输注6000单位/千克。对照组（15例患者）未输注蛋白酶抑制剂。在手术前、手术结束时和手术后12小时测量白细胞计数、血小板计数、凝血酶原时间、活化部分凝血活酶时间以及血浆中PMNE、抗凝血酶（AT）、纤维蛋白/纤维蛋白原降解产物（FDP）、纤维蛋白原、纤溶酶原、纤溶酶 - （α2）纤溶酶抑制剂复合物（PIC）和凝血酶 - 抗凝血酶复合物（TAT）的浓度。
乌司他丁组术后TAT、PIC和FDP显著低于对照组。对照组AT降低，而乌司他丁组未降低，两组间差异有统计学意义。
乌司他丁可抑制腹部手术中的凝血和纤溶。
