三甘氨酰基赖氨酸加压素对肝移植术病人围术期肾功能的影响  

Protective effects of terlipressin on perioperative renal function in patients undergoing liver transplantation

作　　者：许杰[1] 岳云[1] 吴安石[1] 王晖[1] 杜洪印[2] 

机构地区：[1]首都医科大学附属北京朝阳医院麻醉科,100020 [2]天津市第一中心医院麻醉科

出　　处：《中华麻醉学杂志》2008年第2期134-137,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价三甘氨酰基赖氨酸加压素对同种异体肝移植术病人围术期肾功能的影响。方法择期静吸复合麻醉下行经典原位肝移植术的乙，丙肝后肝硬化病人40例，年龄35～55岁，未行静脉-静脉转流术，ASAⅢ或Ⅳ级，按术前肾功能正常与否分层随机分为2组（n=20）：对照组和试验组。手术开始即刻静脉输注三甘氨酰基赖氨酸加压素（2mg溶于50ml生理盐水）10ml／h，至新肝期前即刻，对照组以等容量生理盐水代替。测定麻醉前即刻（T0）、新肝期前即刻（T1）、术毕（T2）、术后1d（T3）和术后2d（T4）尿N-乙酰β-D-氨基葡萄糖苷酶（NAG）和血浆血管紧张素Ⅱ（AT-Ⅱ）、血清岛微球蛋白（β2-MG）、尿素氮（BUN）、肌酐（Cr）浓度，并记录各时段尿量。结果与T0比较，2组T1时尿NAG和血清β2-MG升高（P〈0．01）；与无肝前期比较，2组无肝期尿量减少，新肝期、术后1d和术后2d尿量增加（P〈0．01）；与对照组比较，试验组尿NAG、血浆AT-Ⅱ、血清β2-MG、BUN和Cr浓度及速尿用量降低，尿量增多（P〈0．05），其余指标差异无统计学意义（P〉0．05）。结论肝移植术中静脉输注三甘氨酰基赖氨酸加压素对病人围术期肾功能有保护作用。Objective To investigate the effects of terlipressin on perioperative renal function in patients undergoingliver transplantation. Methods Forty ASA m or patients （31 male, 9 female） aged 35-55 yr weighing 46-81 kg were randomly divided into 2 groups （ n = 20 each） ： terlipressin group and control group. The patients were premedicated with intramuscular midazolam 2-3 mg and atropine 0.5 mg. Swan-ganz catheter was placed via right internal jugular vein and radial artery was caunulated. ECG, BP, HR, CVP and PAP were monitored during anesthesia. Anesthesia was induced with midazolam 0. 1-0.2 mg/kg, fentanyl 5-10 gg/kg, propofol 1-2 mg/kg and vecuronium 0.1 mg/kg and maintained with 0.5-1.5% isoflurane, propefol infusion at 2-5mg·kg^-1· h^-1 and intermittent iv boluses of fentanyl and vecuronium. The patients were mechanically ventilated after tracheal intubation. In terlipressin group 2 mg of terlipressin was added to 50 ml of normal saline （NS） and was continuously infused at 10 ml/h from beginning of operation until the end of anbepatic phase, while in control group NS was infused instead of terlipressin. Blood and urine samples were taken before operation （T0 baseline）, at the end of anhepatic phase （T1） at the end of operation （T2） and on the 1st and 2nd day after operation （T3, T4 ） for determination of plasma AT- Ⅱ , serum β2-MG, BUN and Cr concentrations and NAG concentration in the urine. Urine output was measured during pre-anhepatic, anhepatic and neo-hepatic phase and on the 1st and 2nd day after operation. Results The urinary NAG and serum β2-MG concentrations were significantly increased at T1 as compared with the baseline at To in both groups. The urinary NAG, plasma AT- Ⅱ , serum β2-MG, BUN and Cr concentration were significantly lower and urine output was significantly higher at T2-4 in terlipressin group than in control group. Conclusion Terlipressin has protective effect on renal function in patients undergoing orthotopic liver transplantation.

关 键 词：赖氨酸加压素 肝移植 肾功能试验 

分 类 号：R614[医药卫生—麻醉学]