eNO在肝移植手术中监测缺血再灌注损伤的应用  

The application of the exhaled nitric oxide in ischemia-reperfusion injury during liver transplantation

作　　者：王东春[1] 李萌[1] 刘德胜[1] 严海燕[1] 马鸿雁[1] 安妲 郭雷[1] 李恩有[1] 

机构地区：[1]哈尔滨医科大学附属第一临床医学院麻醉科,黑龙江哈尔滨150001

出　　处：《麻醉安全与质控》2017年第2期67-70,共4页Perioperative Safety and Quality Assurance

摘　　要：目的通过监测肝移植术中呼出气一氧化氮(eNO)的变化,来研究eNO与肝移植手术中缺血/再灌注损伤的关系。方法收集2015-09/2017-02哈尔滨医科大学附属第一临床医学院10例于静吸复合全身麻醉下行原位肝移植术患者。分别于预计无肝期前10 min(T0)、预计新肝期前10 min(T1)、新肝期开始即刻(T2)、新肝期10 min(T3)、新肝期20 min(T4)、新肝期30 min(T5)、手术结束前(T6)采集患者的呼出气和动脉血,分析eNO、乳酸(Lac)。结果所有患者顺利完成手术,术中血流动力学变化明显。T0-T6,eNO先上升后下降,T2与T0相比,eNO显著升高且达到最高值(20.20±5.55 vs 14.40±3.86),T5恢复至T0水平;T0-T6,Lac持续升高;eNO与Lac无相关性。结论肝移植患者进入新肝期eNO显著升高,后又逐渐下降至无肝前期水平,其机制可能与新肝期缺血/再灌注损伤有关。eNO可以作为一个监测肝移植手术中缺血/再灌注损伤的新指标。Objective To explore the relationship between exhaled nitric oxide（eNO） and ischemia-reperfusion injury during liver transplantation through monitoring eNO. Methods A total number of 10 recipients who underwent liver transplantation received general anesthesia at the First Clinical Medicine Affiliated to Harbin Medical University from September 2015 to February 2017. Exhaled gas and arterial blood samples were collected at predict 10 min before anhepatic stage （T0）, predict 10 min before neohepatic stage （T1）, the time of hepato-reperfusion（ T2）, 10 rain of neohepatic stage（T3 ）, 20 min of neohepatic stage（ T4）, 30 min of neohepatic stage（ T5 ） and the end of surgery（T6）, their eNO and lactate （Lac） were measured. Results All patients completed surgery successfully. Hemodynamic changed obviously during the operation. From TO to T6, the level of eNO increased firstly and then decreased. Compared with TO, the level of eNO at T2 was significantly increased and reached the highest value （20.20 ± 5.55 vs 14.40 ± 3.86）, T5 returned to the level of TO ; From TO to T6, the level of Lac gradually increased ; eNO was not significantly correlated with Lac. Conclusion The eNO of liver transplantation patients is significantly increased in the new liver stage, and then gradually decreased to the stage of anhepatic stage. The mechanism may be related to the aischemia-reperfusion injury of the new liver, eNO may be a new index to predict ischemia-reperfusion injury during liver transplantation.

关 键 词：肝移植 呼出气一氧化氮 缺血/再灌注损伤 

分 类 号：R614[医药卫生—麻醉学]