A CLINICAL STUDY OF THE HEMODYNAMICS AND OXIGEN METABOLISM AFTER MASSIVE HEPATECTOMY

Fourteen patients undergone massive hepatectomy over 2 hepatic segments were investigated to determine postoperative significance of systemic and hepatic hemodynamics, oxigen metabolism, including blood levels of polymorphonuclear leukocytic erastase (PMNE) and endothelin (ET-1). In 7 patients, 150, 000 units of ulinastatin was intravenously administered before hepatectomy and 300, 000 units a day after hepatectomy (U group), and another 7 patients without ulinastatin were served as control (C group). Values of PMNE and ET-1 increased immediately after hepatectomy. Ulinastatin suppreseed elevation of them and rapidly recovered to the preoperative level. Postoperative hyperdynamic state was shown in C group but oxigen consumption (VO2) and oxigen extraction ratio (O2ER) decreased. Whereas U group had normodynamic state but VO2 and O2ER increased at postoperative period. The ICG-K value which reflects hepatic blood flow was maintained at the preoperative level in U group. These results suggest that ulinastatin suppresses the increases in PMNE and ET-1 levels, improves the oxigen metabolism, and subsequently exhibits the protection for the hepatic circulation after massive hepatectomy.