肝硬化患者肝移植围术期血浆TXA_2和PGI_2水平变化  

Changes of serum levels of TXA_2 and PGl_2 in cirrhosis patients during liver transplantation

作　　者：黑子清[1] 罗晨芳[1] 黎尚荣[1] 付咏梅[2] 马武华[1] 罗刚健[1] 

机构地区：[1]中山大学附属第三医院麻醉科,广东广州510630 [2]暨南大学医学院病理生理教研室,广东广州510632

出　　处：《中国病理生理杂志》2006年第8期1650-1653,共4页Chinese Journal of Pathophysiology

基　　金：国家自然科学基金资助项目(No.30271254);广东省科技计划项目(No.2004B35001005)

摘　　要：目的:探讨肝硬化患者肝移植围术期前列环素(PG I2)、血栓素(TXA2)的变化、在肝移植围术期的意义及对体、肺循环的影响。方法:24例终末期肝硬化患者接受改良背驮式肝移植术,监测围术期心率(HR)、平均动脉压(MABP)、平均肺动脉压(MPAP)、中心静脉压(CVP)、肺动脉楔压(PAWP)、心指数(C I)、体循环阻力指数(SVR I)、肺循环阻力指数(PVR I)。分别于麻醉后术前、无肝前10 m in、无肝期30 m in、新肝期30 m in和术毕5个时点抽取中心静脉血,用放免法测定血浆TXB2及6-keto-PGF1α水平。结果:①MABP在下腔静脉和门静脉阻断及开放后短期内有一过性下降。②CVP、MPAP和PAWP在肝血管阻断后显著下降;供体肝脏复流后,显著升高。③C I在无肝期明显下降,新肝期10 m in后升高至较术前更高水平。④SVR I和PVR I在无肝期均显著增高;新肝期15 m in内SVR I和PVR I高于术前水平,新肝期30 m in后SVR I显著低于术前水平。⑤与术前值相比,6-keto-PGF1α和TXB2各期显著增加;与阻断前相比,6-keto-PGF1α在新肝期缓慢降低,在术毕时显著降低。结论:肝硬化患者肝移植围术期血浆TXA2、PG I2水平变化显著,一定程度影响了体肺循环。AIM ： To study the changes of serum levels of thromboxane A2 （ TXA2 ） and prostacyclin （ PGI2 ） in cirrhosis patients during liver transplantation. METHODS： Samples were obtained from 24 cirrhosis patients in end at five time points during liver transplantation. TXA2 and PGI2 level were measured by radioimmunoassay. Arterial and mixed venous blood samples used for blood gas analysis were taken at the same time. Intrapulmonary shunt （Qs/Qt） was calculated according to the standard formula. The hemodynamics parameters including continuous cardiac output index （ CI）, HR, mean artery blood pressure （MABP）, MPAP, CVP, PAWP, SVRI, PVRI were measured during liver transplantation. RESULTS： （1） MABP decreased significantly in the：early stage of anhepatic period and neohepatic period. （2） CVP, MPAP and PAWP decreased significantly during anhepatic period. They increased significantly after graft reperfusion and remain the high level. （3） CI declined significantly during anhepatic period and increased at 10 min postreperfusion of new liver. （4） SVRI and PVRI increased during anhepatic period and were higher than baseline level at 15 min after reperfusion. SVRI was lower than baseline level at 30 min after reperfusion. （5） Compared with the baseline level, 6 - keto - PGF1α and TXB2 increased significantly. Compared with the level before vascular cross - clamping, 6 - keto - PGF1α decreased during neohepatic period and it had significant difference in statistics at the end of operation. CONCLUSION： Serum levels of TXA2 and PGI2 significantly change during liver transplantation and may affect the system and pulmonary circulation to some extent.

关 键 词：肝硬化 肝移植 肺 血流动力学 血栓烷A2 依前列醇 

分 类 号：R363[医药卫生—病理学]