麻醉诱导期HSS40对肝部分切除患者肝微循环的影响  

Effects of hepatic microcirculation using low dose HSS40 preoperation on the partial hepatectomy patients in induction of anesthesia

作　　者：陈艳青[1] 袁林[2] 徐又先[3] 

机构地区：[1]广西柳州市人民医院麻醉科,柳州545006 [2]广西柳州市人民医院普通外科,柳州545006 [3]广西柳州市人民医院妇科,柳州545006

出　　处：《国际外科学杂志》2014年第10期662-666,共5页International Journal of Surgery

基　　金：广西区卫生厅医疗卫生科研课题基金项目（No.Z2012575）

摘　　要：目的 探讨麻醉诱导期小剂量HSS40对肝部分切除术患者肝微循环及肝功能的影响.方法 择期肝部分切除术患者65例,采用随机数字表法分成研究组（32例）和对照组（33例）.研究组术前输注HSS40预扩容,剂量均为4 mL/kg,于30 min内输注完毕.对照组术前输注乳酸林格氏液（RL）,剂量和输注速度同研究组.监测两组患者于输注前后不同时间点肝微循环、肝功能指标的变化.结果 与研究组比较,对照组术中输液量（2400±1650） mL及输血量（550±190） mL较多,差异均具有统计学意义（P＜0.05）.对照组一氧化氮于预扩容后T3时（17.84±6.26）μmol/L较术前T0时的（38.06±9.34） μmol/L及研究组T3时（36.37±9.15）μmol/L明显下降（P＜0.05）,而内皮素（ET）T3时的（185.16 ±41.34） pg/mL较术前T0时的（97.84±27.93） pg/mL及研究组T3时（99.75±30.31） pg/mL明显升高（P＜0.05）,且研究组较对照组变化幅度小,时间点稍晚,比较差异均具有统计学意义（P＜0.05）;对照组ALT、AST、DBLI、TBLI在预扩容后上升（P＜0.05）,且明显高于研究组（P＜0.01）,且研究组较对照组变化幅度小,时间点稍晚,比较差异均具有统计学意义（P＜0.05）;而两组中ALB浓度变化不明显,比较差异无统计学意义（P＞0.05）.结论 肝部分切除术患者麻醉诱导期给予小剂量HSS40能保持术中血流动力学稳定,对缺血再灌注损伤肝脏的保护效应明显,可改善肝脏微循环,能更好地维持肝功能的稳定.Objective To study effects of hepatic microcirculation and hepatic function using low dose HSS40 preoperation on the partial hepatectomy patients.Methods Sixty-five partial hepatectomy patients were randomly divided into study group （32 cases with HSS40,4 mL/kg,in 30 min） and control group （33 cases with RL,4 mL/kg,in 30 min）.Patients of two groups were monitored in liver microcirculation,hepatic function parameters at different times before and after the infusion.Results Compared with the study group,the control group were more infusion （2400 ± 1650） mL and blood transfusion （550 ± 190） mL,the differences were statistically significant （P 〈0.05）.Control group of nitric oxide （NO） T3 time（17.84 ±6.26） μmol/L in the preexpansion compared with preoperative T0 time（38.06 ± 9.34） μmol/L and the study groupT3 time （36.37 ± 9.15） μmol/L was significantly decreased （P 〈 0.05）,and endothelin （ET） （T3 time 185.16 ± 41.34 pg/mL） was significantly higher （P 〈 0.05）,and the study group（T3 time 99.75 ± 30.31 pg/mL） than the control group variation amplitude,time later,the difference was statistically significant （P 〈 0.05） ; Control group ALT,AST,DBLI,TBLI rise after preexpansion （P 〈 0.05）,and significantly higher than the study group （P 〈 0.01）,and the study group than the control group variation amplitude,time later,differences were statistically significant （P 〈 0.05） ; while no significant changes in the concentration ALB two groups,the difference was not statistically significant difference （P 〉 0.05）.Conclusion Using low dose HSS40 preoperation on the partial hepatectomy patients can improve cardiovascular stability,protective effect on ischemia-reperfusion injury of liver,can increase the tissue perfusion,and improve the hepatic microcirculation,better able to maintain the stability of the liver function.

关 键 词：麻醉 肝切除术 HSS40 一氧化氮 内皮素 再灌注损伤 

分 类 号：R657.3[医药卫生—外科学]