Objective To investigate the influence of ulinastatin on perioperative myocardial injury in patients undergoing simultaneous pancreas-kidney transplantation and to analyze its possible mechanism.
Methods Eighty patients underwent simultaneous pancreas-kidney transplantation from January 2018 to June 2020, 43 males and 37 females, aged 18-64 years, BMI 20-25 kg/m2, ASA physical status Ⅱ or Ⅲ, were selected into two groups by random number table method: control group (group C) and uselastatin group (group U), 40 patients in each group. Group U administered ulinastatin 300 000 IU after anesthesia induction and repeated every 4 hours until the end of the procedure, group C had equal timing for intravenous infusion of equal volume saline. 6 ml of central venous blood was collected and serum concentrations of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-18 (IL-18), cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB) and the changes in ECG ST segments and T waves were monitored and recorded at 5 minutes after induction of anesthesia (T0), 5 minutes before renal arteriovenous opening(T1), 30 minutes after renal arteriovenous opening (T2), 30 minutes after pancreatic related arteriovenous opening (T3), immediately after surgery (T4), 4 hours after surgery (T5), 24 hours after surgery (T6). The number of intraoperative circulating perfusion, hypertension or hypotension, myocardial ischemia and ventricular premature beats were recorded.
Results Compared with T0, the concentrations of TNF-α, IL-18, cTnI, and CK-MB were significantly increased at T2-T6 in groups C and U (P < 0.05), the concentrations of IL-6 was significantly increased in group C at T2-T5(P < 0.05), and the concentration of IL-6 was significantly increased in group U at T3(P< 0.05). Compared with group C, the concentrations of TNF-α, cTnI, and CK-MB were significantly reduced in group U at T2-T6(P < 0.05), the concentration of IL-6 was significantly reduced in group U at T2-T4(P < 0.05), and the concentration of IL-18 was significantly reduced in group U at T3-T6(P < 0.05). There were 21 patients (52%) in group C and 17 patients (42%) in group U showed ST segment depression or T wave apex at T2, and 26 patients (65%) in group C and 19 patients (48%) in group U showed ST segment depression or T wave apex at T3. There were 13 patients (32%) in group C and 9 patients (22%) in group U needed intravenous dopamine infusion to maintain circulatory perfusion. There were no significantly differences in the incidence of hypertension or hypotension, myocardial ischemia and premature ventricular beats between the two groups.
Conclusion Uinastatin can reduce perioperative myocardial injury, improve cardiac function, and accelerate the recovery process by reducing the long-operative release of inflammatory factors in pancreatic and kidney transplantation. |
