前列腺素E_1与多巴胺对肝移植术患者术中肾功能的影响  

Effects of prostaglandin E_1 and low dose dopamine on renal function in patients undergoing orthotopic liver transplantation

作　　者：张欢[1] 乔青[1] 杨拔贤[1] 孙颖[1] 赵欣[1] 马瑞云[1] 苟淑琴[2] 张秀华[2] 

机构地区：[1]北京大学人民医院麻醉科,100044 [2]北京大学人民医院核医学科,100044

出　　处：《中华麻醉学杂志》2005年第1期15-18,共4页Chinese Journal of Anesthesiology

摘　　要：目的 比较体外静脉-静脉转流下原位肝移植术(OLT)中持续输注前列腺素E1(PGE1)和多巴胺对肾功能的影响。方法 拟行OLT的患者18例,ASAⅢ-Ⅳ级,随机分为二组:前列腺素E1组(P组)和多巴胺组(D组),每组9例。P组和D组于麻醉诱导后分别静脉输注前列腺素E1(0.4-0.8μg·kg-1·h-1)和多巴胺(1-3μg·kg-1·min-1)至术毕。无肝期使用体外静脉-静脉转流。放置Swan-Ganz导管连续监测心输出量(CO)及平均动脉压(MAP)。分别于麻醉前(T1)、无肝前期120min(T2)、无肝期40min(T3)、新肝期60min(T4)及术毕(T5)记录MAP,抽取静脉血并留取尿液,测定血清和尿液β2-微球蛋白(β2-MG)以及血清肌酐(Cr),记录术中总尿量、无肝期尿量及呋塞米用量,计算肌酐清除率(CCr)。结果 与T1相比,P组术中各时点MAP、C-Cr和Cr差异无显著性(P>0.05),T5时血清β2-MG降低,T3-5时尿液β2-MG升高(P<0.05);D组术中各时点CCr和MAP差异无显著性(P>0.05),T2-3时Cr降低,T2-5时血清β2-MG显著性降低,尿液β2-MG升高(P<0.01或0.05)。两组MAP、Cr、CCr、血清β2-MG及尿液β2-MG差异均无显著性(P>0.05)。与P组比较,D组术中总尿量及无肝期尿量增多,术中呋塞米用量减少(P<0.05)。结论 肝移植患者术中持续输注PGE1和多巴胺可在一定程度上扩张肾血管。Objective To evaluate the effects of prostaglandin E1 (PGE1) and low-dose dopamine on renal function during orthotopic liver transplantation (OLT) .Methods Eighteen ASA Ⅲ-Ⅳ patients with end-stage liver diseases undergoing OLT were randomly divided into two groups of 9 patients each : PGE1 group (group P) and low-dose dopamine group (group D). Anesthesia was induced with midazolam 0.1-0.2 mg·kg-1 , fentanyl 5 μg·kg-1 and pipecuronium 0.1 mg·kg1 and maintained with isoflurane inhalation and intermittent i.v. boluses of fentanyi and pipecuronium. The patients were mechanically ventilated after tracheal intubation. PGE1 was infused at 0.4-0.8μg· kg-1 · h-1 in group P and dopamine at 1 -3 μg · kg-1· min in group D after induction until the end of operation. Swan-Ganz catheter was inserted via right internal jugular vein or subclavian vein and radial artery was cannulated. MAP, ECG, CVP, SvO2 , cardiac output ( CO), SpO2 , PET CO2 and core temperature were continuously monitored during operation. Venous blood samples were taken and urine was collected before induction of anesthesia (T1 .baseline), during preanhepatic (T2) anhepatic (T3) and neohepatic phases (T4) and at the end of operation (T5) for determination of serum creatinine (Cr) concentration and serum and urine concentration of β2 -microglobulin (β2-MG). Creatinine clearance ratio (CCr) was calculated. Total urine output during operation and urine output and the amount of furosemide given during anhepatic phase were recorded. Core body temperature was maintained above 35.5℃ during operation. Veno-venous bypass (VVB) was performed during anhepatic phase.Results In group P, compared to baseline there were no significant changes in MAP, Cr and CCr duringoperation, while serum β2-MG decreased significantly at T5 and urine β2-MG increased significantly at T3-5 . In group D serum β2-MG was significantly decreased while urine β2 -MG significantly increased at T2.5 compared to baseline. There was significantly more urine output during anhepatic

关 键 词：前列腺素E1 多巴胺 肝移植 术中 肾功能 

分 类 号：R657.3[医药卫生—外科学]