远端肢体缺血预处理对肝移植患者心脏的保护作用  

Protective Effects of Remote Ischemic Preconditioning on the Hearts of Liver Transplantation Patients

作　　者：修楷文 蔡金贞 温翠丽[1] 董河[1] 

机构地区：[1]青岛大学附属医院,山东 青岛

出　　处：《临床医学进展》2023年第1期608-615,共8页Advances in Clinical Medicine

摘　　要：目的:研究远隔肢体缺血预处理(remote ischemic preconditioning, RIPC)对肝移植患者心脏的保护作用和价值。方法:67例择期在全麻下行经典原位肝移植患者,按照随机数字表法分为缺血预处理组(P组) 35例和对照组(C组) 32例。P组于手术开始10 min后行肢体缺血预处理:于左下肢根部绑止血带,以200 mmHg压力充气阻断下肢血流10 min,再放气恢复循环5 min,如此重复3次。C组于左下肢绑止血带40 min不进行充气放气操作。收集患者入室后(T0)、切皮前(T1)、下腔静脉阻断后5 min (T2)、门静脉开放后5 min (T3)、术毕(T4),检测mABP、HR、PAP、CI、SVR。检测各时点血清中cTnI、CK-MB和LDH含量。观察两组患者门静脉开放后发生恶性心律失常情况及术后情况。结果:T3时P组患者CI、SVR明显高于C组,PAP明显低于C组(p 0.05)。结论:远隔肢体缺血预处理对肝移植患者心脏有保护作用,减少心脏不良事件发生。Objective: To observe the protective effects and value of remote ischemic preconditioning on the hearts of liver transplantation patients. Methods: 67 patients underwent classical orthotopic liver transplantation were randomly divided into Remote-ischaemic preconditioning group (group P) in-cluding 35 patients and routine group (group C) including 32 patients according to random number table. Give group P remote ischemic preconditioning after 10 minutes of the operation beginning: Tie-up a tourniquet 10 min at the base of the left lower limb, block blood lower limb flow with 200 Hg pressure, then deflate 5 min to recover the circulating blood flow, repeat 3 times. Tie-up group C a tourniquet 40 minutes at the base of the left lower limb, don’t operate the inflation and deflation. Record the mABP, HR, PAP, CI, SVR after entering the room (T0), before skin resection (T1), inferior vena occlusion for 5 min (T2), portal vein reperfusion for 5 min (T3), and after operation (T4), and the changes of myocardial enzymes (including cTnI, CK-MB and LDH) at any time. Observe the malig-nant arrhythmias occurring after portal vein reperfusion and postoperative condition. Results: Compared with Group-C, the CI and SVR in Group-P are higher (p 3, the HR and mABP are higher (p 0.05). Conclusion: Remote ischemic preconditioning can protect myocardium of liver transplantation patients and reduce adverse car-diac events.

关 键 词：肝移植 远端肢体缺血预处理 心肌保护 缺血–再灌注损伤 

分 类 号：R65[医药卫生—外科学]