去甲肾上腺素对原位肝移植患者胃黏膜pH值的影响  

Effect of norepinephrine on the gastric intraumucosal pH during orthotopic liver transplantation

作　　者：陈绪贵[1] 曹蕾[1] 王勇[1] 

机构地区：[1]北京军区总医院附属八一脑科医院麻醉科,100700

出　　处：《临床麻醉学杂志》2011年第8期784-786,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨去甲肾上腺素对原位肝移植患者胃黏膜pH值（pHi）的影响。方法原位肝移植手术患者24例，随机均分为去甲肾上腺素组（N组）和多巴胺组（D组），分别于术前（L）、无肝前期30min（T1）、无肝期30min（T2）、新肝期5min（T3）、90min（T4）、术毕（T5）记录患者HR、MAP、PaCO2和胃黏膜二氧化碳分压（PgC02）并计算pHi。结果T2、L时D组HR明显增快，MAP显著降低（P〈0．05），N组变化差异无统计学意义。T1～T3时两组pHi均明显降低，且D组显著低于N组（P〈0．05）。结论原位肝移植术中积极补充容量的同时应用去甲肾上腺素能更有效维护血流动力学稳定，改善胃肠黏膜灌注。Objective To investigate the effect of pH during orthotopic liver transplantation. Methods norepinephrine on the Twenty-four adult gastric intraumucosal patients undergoing orthotopic liver transplantation were randomly divided in two groups： dopamine group （group D, n= 12） and norepinephrine group （group N, n= 12）. Norepinephrine （group N） or Dopamine （group D） was infused respectively to maintain mean arterial blood pressure （MAP） at 60-100 mm Hg during orthotopic liver transplantation. Gastric intramucosal PCO2 （PgCO2） and PaCO2 were measured, and phi were calculated at the follow time points： preoperation（T0 ）, 30 min at pre-anhepatic phase（T1 ）, 30 min at anhepatic phase（T2）, 5 min（T3 ）, 90 min（T4 ） after reperfusion and the end of operation （T5）. Results HR increased and MAP decreased significantly at TO, TO compared with To in group D （P（0. 05）. At the time points of T1-T3, pHi decreased significantly in both groups and was significantly higher in group N than those in group D. Conclusion After sufficient fluid expansion, norepinephrine can maintain homodynamic stability and improve gastrointestinal microcirculation during orthotopic liver transplantation.

关 键 词：去甲肾上腺素 原位肝移植 胃黏膜PH 

分 类 号：R657.3[医药卫生—外科学]