肠道淤血再灌注对肝移植手术中患者全身血流动力学影响的研究进展  

RESEARCH ADVANCES IN THE EFFECT OF INTESTINAL CONGESTION-REPERFUSION ON SYSTEMIC HEMODYNAMICS DURING LIVER TRANSPLANTATION

作　　者：王金山[1] 刘文娜[2] 王永旺 WANG Jinshan;LIU Wenna;WANG Yongwang(Department of Anesthesiology,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院移植外科,天津300192 [2]天津医科大学朱宪彝纪念医院麻醉科,天津市内分泌研究所,国家卫健委激素与发育重点实验室,天津市代谢性疾病重点实验室 [3]桂林医学院附属医院麻醉科

出　　处：《精准医学杂志》2022年第5期465-470,共6页Journal of Precision Medicine

基　　金：广西壮族自治区卫健委自筹科研基金(Z202008-69);天津市教委科研计划项目(2020KJ192);桂林市技术应用与推广计划(2020011204-15;20210227-4);广西区自然科学基金项目(2022JJA140025)。

摘　　要：肝移植手术是治疗终末期肝病的有效方法。肝移植过程中为减少术中出血需阻断门静脉,肠黏膜发生淤血再灌注损伤,不可避免地引起肠黏膜通透性增加,细菌和内毒素移位,同时可诱发机体发生炎性递质级联放大反应;当新肝期开放门静脉,产生的内毒素以及炎性递质等进入体循环,导致血流动力学的剧烈波动,严重者可导致多器官功能障碍。故研究肠道淤血再灌注损伤中各种递质成分对血流动力学的影响,可以更好地调控术中循环系统的变化,并降低麻醉的管理难度。Liver transplantation is an effective treatment method for end-stage liver disease.Since the portal vein needs to be occluded to reduce intraoperative bleeding during liver transplantation,congestion-reperfusion injury of the intestinal mucosa may occur and inevitably lead to the increase in intestinal mucosal permeability,the translocation of bacteria and endotoxin,and even the cascade amplification of inflammatory mediators in the human body.When the portal vein is opened in the new liver stage,the endotoxin and inflammatory mediators produced enter the systemic circulation,leading to severe fluctuations in hemodynamics and even multiple organ dysfunction in severe cases.Therefore,it is necessary to investigate the effect of various mediators in intestinal congestion-reperfusion injury on hemodynamics,in order to better regulate the intraoperative changes of the circulatory system and reduce the difficulty of anesthesia management.

关 键 词：肝移植 再灌注损伤 肠黏膜 内毒素类 细胞因子类 活性氧 血流动力学 综述 

分 类 号：R657.3[医药卫生—外科学] R617[医药卫生—临床医学]