控制性低中心静脉压用于原位肝移植术的临床研究  

Clinical Application of Controlled Low Central Venous Pressure in Orthotopic Liver Transplantation

作　　者：胡衍辉[1] 薛广燕[1] 周志东[1] 卢忆梅[1] 王海滨[2] 

机构地区：[1]南昌大学第二附属医院麻醉科,江西南昌330006 [2]上海交通大学附属瑞金医院麻醉科,上海200025

出　　处：《中国临床医学》2008年第5期677-679,共3页Chinese Journal of Clinical Medicine

基　　金：江西省卫生厅资助课题(项目编号20061087)

摘　　要：目的:探讨控制性低中心静脉压用于原位肝移植术的安全性和有效性。方法:40例ASAⅡ～Ⅳ级原位肝移植手术患者,随机分为正常中心静脉压组(C组,n=20)和控制性低中心静脉压组(L组,n=20)。C组术中维持中心静脉压6～12cm H2O,而L组则控制中心静脉压于2～5cm H2O。分别于术前(T1)、无肝期(T2)、新肝期30min(T3)、新肝期6h(T4)及新肝期24h(T5)经中心静脉抽血检测患者血浆肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、内皮素(ET-1)的浓度水平,同时观察患者T3、T4、T5时点谷丙转氨酶(ALT)和谷草转氨酶(AST)的变化以及T1、T5时点尿素氮(BUN)和肌酐(Cr)的变化,并记录术中失血量和输血量。结果:两组TNF-α、IL-6、ET-1水平从T3开始升高,两组的TNF-α、IL-6、ET-1自T3至T5时点与T1相比有显著差异(P<0.01)。而C组的TNF-α、IL-6、ET-1自T3至T5时点与L组相应各时点相比有显著升高(P<0.05)。C组的ALT和AST与L组相应各时点相比有显著升高(P<0.01)。术后未出现肾功能损害。L组术中失血量和输血量明显少于C组(P<0.01)。结论:原位肝移植手术中辅助应用控制性低中心静脉压技术不仅有效地减少手术中的失血量和输血量,而且可减轻移植供肝的缺血再灌注损伤,最大限度地保护移植新肝功能,并对患者肾脏功能亦有所保护。Objective：To investigate the security and effectivity of controlled low central venous pressure on ortbotopic liver transplantation. Methods：Forty ASAⅡ～Ⅳ patients scheduled for ortbotopic liver transplantation were randomly allocated to one of the two groups： normal central venous pressure group （group C, n = 20） and controlled low central venous pressure group （group L, n = 20）. Group C was managed by normal central venous pressure （6～12 cm H2O）,while group L was per formed routinely with controlled central venous pressure（2～5 cm H2O）. The levels of TNF-α,IL-6 and ET-1 were measured before operation （T1）, anhepatic phase （T2）, 30 min, 6 h and 24 h after reperfusion phase （T3 ,T4 ,T5 ）. Plasma levels of alanine aminotransferase （ALT）, aspartate aminotransferase （AST） 30min, 6 h and 24 h after reperfusion phase were measured. Concentrations of blood urea nitrogen and serum creatinine before operation, 24 h after reperfusion phase were measured. The volume of blood loss and volume of blood transfused were measured. Results： The levels of TNF-α,IL 6 and ET-1 were significantly increased at T3 ,T4 ,Ts in two groups. The levels of TNF-α,IL-6 , ET-1 ALT and AST in the T3 ,T4 and Ts in group L were lower than those in group C （P〈0.05 or P〈0.01）. Renal function was not affected by controlled low central venous pressure. The volume of blood loss and volume of blood transfused in group L were significantly less than that of group C（P〈0.01）. Conclusion： The controlled low central venous pressure during orthotopic liver transplantation is effective in reducing blood loss and blood infusion, reducing liver ischemia-reperfusion injury,and may be beneficial for renal function.

关 键 词：中心静脉压 肝移植 缺血-再灌注损伤 输血 

分 类 号：R657.3[医药卫生—外科学]