戊乙奎醚对肝移植术患者新肝期炎性反应的影响  

Effects of penehyclidine on inflammatory response during neo-hepatic phase in patients undergoing orthotopic liver transplantation

作　　者：董兰[1] 李树人[3] 韩曙君[1] 臧运金[2] 雷志礼[1] 马宁[3] 杨国山[4] 李长燕[4] 

机构地区：[1]北京武警总医院麻醉科,100039 [2]北京武警总医院移植科,100039 [3]首都医科大学附属北京友谊医院麻醉科 [4]军事医学科学院

出　　处：《中华麻醉学杂志》2008年第10期922-924,共3页Chinese Journal of Anesthesiology

摘　　要：目的探讨戊乙奎醚对肝移植术患者新肝期炎性反应的影响。方法择期肝移植术患者60例，ASAⅡ或Ⅲ级，年龄20～64岁，体重46—83kg，随机分为3组（n=20）：对照组（C组）、戊乙奎醚0．1mg／kg组（Ⅰ组）和戊乙奎醚0．2mg／kg组（Ⅱ组）。均采用静吸复合全麻，于无肝期30min开始，Ⅰ组和Ⅱ组分别静脉输注戊乙奎醚0．1、0．2mg／kg，C组静脉输注等容量生理盐水。分别于无肝期30min（T0）、再灌注1、2、3、24h（T1-4）时取上腔静脉血3ml，放免法测定血清TNF-α及IL-1浓度，于T3时取新肝组织，测定肝细胞NF-κB蛋白表达及其活性；光镜下观察新肝病理学结果。结果与C组比较，Ⅰ组，T1、Ⅱ组T1～3时血清，TNF-α浓度降低，Ⅰ组和Ⅱ组，T1，3时血清IL-1浓度降低，肝细胞NF-κB蛋白表达下调、活性降低（P〈0．05）；与Ⅰ组比较，Ⅱ组T1,2时血清TNF-α浓度降低，肝细胞NF-κB蛋白表达下调（P〈0．05）；Ⅰ组和Ⅱ组肝缺血再灌注损伤较C组减轻。结论戊乙奎醚可通过抑制肝细胞NF-κB蛋白表达及其活性，降低肝移植术患者新肝期的炎性反应，从而减轻肝缺血再灌注损伤。Objective To investigate the effects of penehyclidine on serum concentrations of TNF-α and IL-1 and liver NF-κB protein expression in patients undergoing orthotopic liver transplantation （OLT）. Methods Sixty ASA Ⅱ or Ⅲ patients aged 20-64 yr weighing 46-83 kg undergoing elective OLT under combined intravenous-inhalational anesthesia were randomly divided into 3 groups （ n = 20 each） ： group Ⅰ and Ⅱ received penehyclidine 0. 1 and 0.2 mg/kg in 100 ml normal saline infused iv at 1.5 ml/min respectively, starting from 30 min of anhepatic phase, while group Ⅲ （control group） received equal volume of normal saline at the same infusion rate instead of penehyclidine. Blood samples were taken from superior vena cava at 30 min of anhepatic phase （ T0 ） and at 1 （ T1 ）, 2 （T2）, 3 （T3） and 24 h （T4） after beginning of hepatic reperfusion for determination of serum concentrations of TNF-α and IL-1. Hepatic specimens were obtained at T3 for determination of NF-κB protein expression and its target gene binding activity and microscopic examination. Results The serum TNF-α concentrations at T1 in group Ⅰ and at T1,3 in group Ⅱ and IL-1 concentration at T1,3 and the hepatic NF-κB protein expression and activity were significantly lower in group Ⅰ and Ⅱ than in Control group. Serum TNF-α concentration at T1,2 and hepatic NF-κB protein expression were significantly lower in group Ⅱ than in group Ⅰ . Microscopic examination showed that hepatic ischemia-reperfusion was less severe in group Ⅰ and Ⅱ than in control group. Conclusion Penehyclidine can ameliorate ischemia-reperfusion injury to the transplanted liver by attenuating the inflammatory response through inhibition of hepatic NF-κB protein expression and activity in patients undergoing OLT.

关 键 词：胆碱能拮抗剂 肝移植 再灌注损伤 

分 类 号：R657.3[医药卫生—外科学] R614[医药卫生—临床医学]