猪肝移植时ET-1、NO与血流动力学及肝功能损伤的关系  

Study on relationship between serum endothelin-1、NO and hemodynamics and liver function in pig orthotopic liver transplantation

作　　者：谢伟斌[1] 朱亚青[2] 刘卫东[1] 张小春[1] 许锁宝[2] 张盛[2] 苏工[1] 许琪[1] 曾因明[3] 

机构地区：[1]江苏省常州市第三人民医院麻醉科,213001 [2]江苏省常州市第三人民医院外科,213001 [3]江苏省麻醉医学研究所

出　　处：《国际麻醉学与复苏杂志》2009年第6期525-528,共4页International Journal of Anesthesiology and Resuscitation

基　　金：江苏省教育厅重点实验室开放课题（KJS04007）,江苏省常州市社会发展计划项目（CS2004211,CS2004213）

摘　　要：目的探讨猪肝移植术后早期血管调节基因血管内皮素-1（ET-1）、一氧化氮（NO）与血流动力学及移植肝功能损伤的关系。方法将38头猪随机等分为2组，分别为供体组和受体组，建立猪原位肝移植模型19个，监测受体血流动力学指标，检测猪肝移植术前、后各时相肝功能及血清ET-1、NO的水平，分析ET-1、NO水平与血流动力学改变和肝功能损伤间的相互关系。结果血清ET-1和NO水平在再灌注后快速上升，再灌注30min时达高峰，ET-1／NO比值也在再灌注30min时达最高。再灌注30min时，平均动脉压（MAP）与ET-1水平和ET-1／NO比值呈正相关；再灌注5min时MAP、中心静脉压（CVP）与NO水平呈负相关；再灌注30min时，血清谷丙转氨酶（ALT）与ET-1水平和ET-1／NO比值呈正相关，ET-1和NO与其他指标无相关性。结论血清ET-1／NO平衡紊乱是血流动力学紊乱和移植肝损伤的重要机制之一。ET-1可加重肝细胞的缺氧，导致肝细胞损伤；NO通过改善肝脏微循环，在肝脏缺血，再灌注损伤中对肝脏功能起保护作用。Objective To investigate the relationship between changes of serum endothelin-1 （ET-1） and nitric oxide （NO） and changes in hemodynamics and liver function in pigs with orthotopic liver transplantation（OLTx）. Methods 38 healthy pigs were set at random with 19 donators and 19 receivers. The hemodynamic changes were continuously monitored during the operating phases. The serum ALT, AST, TBIL, ALB and ET-1, NO levels before operation, during anhepatic phase, at 5 and 30 minutes after reperfusion, and at operation end were measured. Results The serum ET-1 and NO levels and the ratio of ET-1/NO increased obviously and reached the peak values at 30 mins after reperfusion. At 30 mins after reperfusion, the level of MAP was positively correlated with the serum ET-1 and ratio of ET-1/NO. At 5 mins after reperfusion, the level of MAP and CVP were negatively correlated with the serum NO. At 30 mins after reperfusion, the level of ALT was positively correlated with the serum ET-1 and ratio of ET-lfNO. Conclusion The imbalance of serum ET-1 and NO may be important mechanism leading to hemodynamics changes due to graft. The serum ET-1 may cause hypoxic damage of hepatocyte. NO may improve microcirculation of liver, and play a protective reperfusion in OLTs.

关 键 词：原位肝移植术 猪 ET-1 NO 血流动力学 肝功能 

分 类 号：R657.3[医药卫生—外科学] R654.1[医药卫生—临床医学]