罗格列酮对肝移植围术期肺功能的影响  

Effect of rosiglitazone on perioperative pulmonary function in patients undergoing orthotopic liver transplantation

作　　者：刘德昭[1] 黄品婕[1] 葛缅[1] 黑子清[1] 

机构地区：[1]中山大学附属第三医院麻醉科,广州市510630

出　　处：《临床麻醉学杂志》2014年第4期317-320,共4页Journal of Clinical Anesthesiology

基　　金：广东省科技计划项目(2011B031800058);贝朗麻醉科学研究基金(201101);广东省中医药局基金(20121143)

摘　　要：目的探讨罗格列酮对肝移植围术期肺功能的影响。方法选择2009-2012年原位肝移植手术终末期肝硬化患者50例，年龄43-62岁，ASAⅡ～Ⅳ级，按照随机数字法分为两组：罗格列酮组（R组）与生理盐水对照组（N组），每组25例。R组患者在麻醉诱导前和术毕后分别将罗格列酮4mg用生理盐水稀释至10m1后经胃管注入；N组用等容量生理盐水替代。记录两组的气道峰压（PIP）、平均气道压（Pmean）、肺动态顺应性（Cdyn）、PaO2、肺泡气-动脉血氧分压差[P（A-a）O2]、氧合指数（OI）、呼吸指数（RI）等呼吸力学和肺功能指标，以及呼出气冷凝液中TNF-a、IL-8、IL-10的含量和术后肺部并发症情况。结果与N组比较，R组术毕和术后24h的P（A-a）O2、PIP、Pmean、RI明显降低，Cdyn和OI明显升高（P〈0．05）；呼出气冷凝液中TNF-a、IL-8均明显降低（P〈0．05），IL-10明显增高（P〈0．05）。R组术后7d内急性肺损伤（ALI）和肺部感染发生率明显低于N组（P〈0．05）。结论罗格列酮可改善原位肝移植围术期患者的肺功能。Objective To explore the protective effect of rosiglitazone on perioperative pulmonary function in patients undergoing orthotopic liver transplantation （OLT）. Methods Fifty OLT patients with end-stage cirrhosis were enrolled and randomly allocated into two groups with 25 patients each as follows： rosiglitazone group （group R） and normal saline group （group N）. Before anesthesia induction and I hour immediately after operation, rosiglitazone 4 mg diluted to 10 ml by saline or e- qual volume of normal saline was administered via stomach tube in R and N group, respectively. Respiratory parameters including peak inspiratory pressure （PIP）, mean inspiratory pressure （Pmean）, pulmonary dynamic compliance （Cdyn）, partial pressure of arterial oxygen （PaO2）, alveolar-arterial oxygen difference （P（A-a）O2 ）, oxygenation index （OI）, and respiratory index （RI） were compared between the two groups. Inflammatory cytokines TNF-a, IL-8, and IL-10 in exhaled breath condensate （EBC） and postoperative respiratory complications were evaluated. Results Immediately or 24 h after operation, P（A-a）O2, PIP, Pmean, RI decreased while Cdyn and OI increased significantly in group R compared with those of group N（P〈0.05）. Besides, immediately or 24 h after operation, TNF-a and IL-8 in EBC decreased while IL-10 increased in group R compared with those of group N （P〈0. 05）. The incidence of acute lung injury （ALI） and respiratory infection in group R was lower than that of group N following 7 days afer opearion （P〈0. 05）. Conclusion Rosiglitazone can ameliorate postop- erative respiratory function in patients undergoing orthotopic liver transplantation.

关 键 词：罗格列酮 原位肝移植 肺保护 

分 类 号：R657.3[医药卫生—外科学]