山莨菪碱在非转流经典原位肝移植中的应用  

Application of anisodamine in orthotopic liver transplantation without venovenous bypass

作　　者：朱宇麟[1] 景桂霞[1] 李小刚[1] 刘齐宁[1] 高燕风[1] 朱敦[1] 

机构地区：[1]西安交通大学医学院第一附属医院麻醉科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2007年第6期696-699,共4页Journal of Xi’an Jiaotong University（Medical Sciences）

摘　　要：目的观察山莨菪碱对非转流经典原位肝移植术血流动力学、氧代谢和肾功能的影响。方法选择行非转流经典原位肝移植患者30例,ASA分级Ⅲ-Ⅳ,随机分为山莨菪碱组和对照组,每组15例。山莨菪碱组术中使用1 g/L山莨菪碱10 mg/h,对照组使用相同容量的生理盐水。分别于术前、无肝期前、无肝期30 min、新肝期60 min和术毕测定血流动力学、组织氧代谢和肾功能指标。结果与无肝期前相比,两组无肝期30 min中心静脉压(CVP)明显降低,新肝期60 min CVP明显升高(P<0.05);两组间各时点的心率(HR)、平均动脉压(MAP)和CVP均无显著性差异(P>0.05);两组手术时间、无肝期时间、出血量、总入量均无显著性差异(P>0.05);与对照组相比,山莨菪碱组尿量显著增多(P<0.05),而速尿的用量显著减少(P<0.05);两组肌酐(Cr)和β2-微球蛋白(β2-MG)术中各时点与术前相比及两组之间相比差异均无统计学意义(P>0.05)。与术前比较,两组无肝期30 min乳酸盐(LAC)水平明显增高,持续至术毕(P<0.01);与对照组相比,山莨菪碱组在无肝期30 min后各时点LAC明显降低(P<0.05)。结论肝移植术中使用山莨菪碱能改善组织微循环,增加术中尿量,对改善肾功能有一定意义。Objective To observe the effects of anisodamine on hemodynamics, oxygen metabolism and renal function in orthotopic liver tansplantation without venovenous bypass. Methods Thirty ASA Ⅲ - Ⅳ patients undergoing orthotopic liver transplantation without venovenous bypass were randomly divided into two groups of 15 patients in each： anisodamine group and control group. 1 g/L anisodamine was infused at 10 mg/h in anisodamine group and the same volume of saline was infused in control group. The parameters of hemodynamics, oxygen metabolism and renal function were recorded at preoperational period, preanhepatic phase, 30 min at anhepatic phase, 60 min at neohepatic phase and at the end of operation. Results In both groups, compared with that before operation, central venous pressure （CVP） decreased at 30min of anhepatic phase significantly and increased at 60min of neohepatic phase significantly （P〈0.05）. There were no significant differences in heart rate, mean arterial pressure and CVP between the two groups at each time point （P〉0.05）. The two groups did not differ significantly in duration of operation and anhepatic phase, volume of hemorrhage and transfusion. Compared with control group, there was more urine output and less furosemide in anisodamine group （P〈 0.05）. In the two groups, there were no significant differences in creatinine （Cr） and β2 -microglobulin （β2 -MG） not only compared with preoperation but also between each time point （P〉0.05）. The lactate （LAC） level increased significantly at 30 min of anhepatic phase and lasted until the end of operation compared with preoperation, but LAC level at the time point after 30 min of anhepatic phase was significantly lower in anisodamine group than in control group （P〈0.05）. Gonclusion Using anisodamine in liver tansplantation could ameliorate microcirculation and increase urine output, which may be helpful in improving renal function during liver transplantation.

关 键 词：肝移植 微循环 肾功能 山莨菪碱 

分 类 号：Q972[生物学]