CAJ | 학술논문

目的评价再灌注初期控制性降压对肝叶切除术病人肝缺血再灌注损伤的影响.方法择期行肝叶切除术病人40例,性别不限,年龄30～60岁,体重40～70kg,ASA分级Ⅱ或Ⅲ级,将病人按分层随机方法分为2组(n=20),对照组(C组)开放肝门后10 min期间维持MAP 75～100mm Hg,控制性降压组(H组)于开放肝门前2 min开始静脉输注硝酸甘油3～6μg·kg-1·min-1实施控制性降压,再灌注10 min期间维持MAP 60～70 mm Hg.分别于缺血前(基础状态)、缺血15 min和再灌注25min时采集静脉血样,测定血浆内皮素(ET)、一氧化氮(NO)、TNF-α和IL-1的浓度.结果与基础值比较,两组缺血15 min和再灌注25min时血浆ET、TNF-α和IL-1的浓度升高,血浆N0浓度降低(P＜0.05);与C组比较,H组再灌注25min时血浆ET、TNF-α和IL-1的浓度降低,血浆NO浓度升高(P＜0.05).结论再灌注初期控制性降压10 min可减轻肝叶切除术病人肝缺血再灌注损伤,其机制与调节肝窦内皮细胞ET和NO的平衡及抑制炎性反应有关.
목적 평개재관주초기공제성강압대간협절제술병인간결혈재관주손상적영향.방법 택기행간협절제술병인40례,성별불한,년령30～60세,체중40～70kg,ASA분급Ⅱ혹Ⅲ급,장병인안분층수궤방법분위2조(n=20),대조조(C조)개방간문후10 min기간유지MAP 75～100mm Hg,공제성강압조(H조)우개방간문전2 min개시정맥수주초산감유3～6μg·kg-1·min-1실시공제성강압,재관주10 min기간유지MAP 60～70 mm Hg.분별우결혈전(기출상태)、결혈15 min화재관주25min시채집정맥혈양,측정혈장내피소(ET)、일양화담(NO)、TNF-α화IL-1적농도.결과 여기출치비교,량조결혈15 min화재관주25min시혈장ET、TNF-α화IL-1적농도승고,혈장N0농도강저(P＜0.05);여C조비교,H조재관주25min시혈장ET、TNF-α화IL-1적농도강저,혈장NO농도승고(P＜0.05).결론 재관주초기공제성강압10 min가감경간협절제술병인간결혈재관주손상,기궤제여조절간두내피세포ET화NO적평형급억제염성반응유관.
Objective To evaluate the effect of controlled hypotension at the beginning of reperfusion on ischemia-reperfusion (I/R) injury of the liver in patients undergoing hepatectomy. Methods Forty ASA Ⅱ or Ⅲ patients aged 30-60 yr weighing 40-70 kg undergoing elective partial hepatectomy for liver cancer were randomly divided into 2 groups ( n = 20 each): group C normal BP and group H controlled hypotension. Hepatic portal was occluded during operation. In group C normal BP was maintained during reperfusion while in group H controlled hypotension (MAP was maintained at 60-70 mm Hg) was performed for 10 min since the beginning of reperfusion.Venous blood samples were taken before hepatic ischemia (T0 ,baseline) and at 15 min of ischemia (T1) and 25 min of reperfnsion (T2 ) for determination of plasma endothelin (ET), nitric oxide(NO), TNF-α and IL-1 concentrations. Results I/R of the liver led to significant increase in plasma ET, TNF-α and IL-1 concentrations and decrease in plasma NO concentration at T1,2 as compared with the baseline values at T0 in both groups. Plasma ET,TNF-α and IL- 1 concentrations were significantly lower while plasma NO concentration was significantly higher at T2 in group H than in group C. Conclusion Ten minutes controlled hypotension in the initial stage of reperfusion can attenuate I/R-induced injury to the liver in patients undergoing hepatectomy by balancing ET with NO and inhibiting inflammation response.