经典原位肝移植围术期肺血管通透性和内皮素-1浓度的变化  

Perioperative changes in pulmonary vascular permeability and endothelin-1 concentration in patients undergoing classic orthotopic liver transplantation

作　　者：盛恒炜[1] 冯子铭[1] 屠伟峰[1] 

机构地区：[1]广州军区广州总医院麻醉科,广东广州510010

出　　处：《热带医学杂志》2013年第3期318-320,共3页Journal of Tropical Medicine

基　　金：广东省医学科研基金(B2010256)

摘　　要：目的观察经典原位肝移植(OLT)围术期血管外肺水指数(EVLWI)、肺血管通透性指数(PVPI)和内皮素-1(ET-1)的变化规律。方法 26例终末期肝病拟行OLT患者,围术期采用全凭静脉麻醉维持,经右颈内静脉和右股动脉放置PiCCO导管,通过PiCCO监护仪测定基础值(T1)、无肝期30min(T2)、新肝期30min(T3)、新肝期90min(T4)及关腹前10min(T5)的EVLWI和PVPI,同时在上述对应时间点抽取静脉血液,通过放免法检测血清中ET-1浓度。结果与基础值比较,EVLWI、PVPI及ET-1在T3、T4及T5时点明显升高(P<0.05);与T2比较,PVPI在T3时点及ET-1在T3和T4时点明显增加(P<0.05);与T3比较,ET-1在T5时点明显降低(P<0.05)。结论非转流经典原位肝移植术新肝期EVLWI、PVPI和EI-1明显增高,提示存在肺损伤的可能。Objective To investigate the perioperative changes in extravascular lung water index （EVLWI）, pulmonary vascular permeability index （PVPI） and endothelin-1 （ET-1） concentration in patients undergoing classic orthotopic liver transplantion （OLT） without anhepatic veno-venous bypass. Methods 26 patients undergoing OLT were maintained with intravenous target controlled infusion anesthetics. PiCCO catheter was inserted via right internal jugular vein and femoral artery. The values of EVLWI and PVPI at the baseline （T1）, 30 min after anhepatic phase （T2）, 30 min after reperfusion （T3）, 90 min after reperfusion （T4）, and 10 min before the closure of peritoneum （3＂5） were measured. Meanwhile, 6 ml of blood was collected for the determination of ET-1 concentration at the above mentioned time points. Results EVLWI, PVPI and ET-1 concentration were increased significantly at T3, T4, and T5 when compared with the baseline （T1） （P〈0.05）. PVPI at T3 and ET-1 concentration at T3 and T4 were dramatically enhanced by comparison with T2 （P〈0.05） Comparing with T3, ET-1 concentration at T5 was markedly reduced （P〈0.05）. Conclusion EVLWI, PVPI and ET-1 were greatly increased after reperfusion. The findings indicate that acute lung injury may occur in patients undergoing OLT.

关 键 词：肝移植 血管外肺水 肺血管通透性 内皮素-1 

分 类 号：R657.3[医药卫生—外科学]