肝移植手术中心血管活性物质对血流动力学和肾功能的影响

Effects of cardiovascular active substances on hemodynamics and renal function in patients undergoing liver transplantation

目的探讨血浆肾上腺髓质素(ADM)、心房利钠肽(ANP)、内皮素(ET)、血栓素A2(TXA2)和前列环素(PGI2)对肝移植术中血流动力学及肾功能的影响。方法肝移植手术患者18例,测定麻醉诱导后(T0)、无肝期5 min(T1)和30 min(T2)、新肝期5 min(T3)和60 min(T4)及关腹时(T5)血浆ADM、ANP、ET、TXA2及PGI2的浓度。记录HR、BP、平均肺动脉压(MPAP)、肺动脉楔压(PAWP)、CVP及肾功能指标的变化。结果与T0比较,ADM在T4及T5时明显升高(P<0.01);ANP从T1～T5进行性下降(P<0.05或P<0.01)。T3时ET含量最低(P<0.05)。T0～T5时TXA2和PGI2持续高于正常值,T4时PGI2显著下降(P<0.05)。与T0比较,T1和T3时SBP、DBP显著下降(P<0.01);HR在T1～T4时增快(P<0.01)。T1、T2时CVP、PAWP及MPAP明显下降(P<0.01)。无肝期前后血清尿素氮(BUN)和肌酐(Cr)有增高趋势,肌酐清除率(CCr)有下降趋势。与无肝前期比较,无肝期尿量减少(P<0.05),术中尿红细胞、隐血及蛋白增加。结论心血管活性物质与血流动力学显著相关,肝移植术中血浆ADM、ANP、ET、TXA2和PGI2的变化与血流动力学波动及肾小球滤过和屏障功能下降有关。

Objective To study the effects of adrenomedullin（ADM）, atrial natriuretic peptide （ANP）, endothelin （ET）, thromboxane A2 （TXA2）and prostaeyclin （PGI2） in plasma on hemodynamics and renal function in the patients undergoing liver transplantation（LT）. Methods Concentrations of plasma ADM, ANP, ET, TXA2 and PGI2 were measured in 18 patients undergoing LT after anesthesia induction（T0 ）, at 5 min（T1 ） and 30 min（T2 ） of anhepatic period, 5 min（T3 ） and 60 min（T4 ） of neohepatie period, and at the end of surgery（T5 ）. HR, BP, mean pulmonary artery pressure（MPAP）, pulmonary arterial wedge pressure （PAWP）, central venous pressure（CVP）,and renal function were recorded. Results Compared to To, ADM elevated significantly at T4 and T5 （P〈 0.01）, ANP decreased gradually from T1 to T5 （P〈0.05 or P〈0. 01）, ET decreased at T3 （P〈 0.05）. TXA2 and PGI2 were higher than normal values, while PGI2 reduced at T4 （P〈0. 05）. Compared with To, SBP and DBP decreased at TI and T3, HR at T1-T4 increased significantly（P〈 0.01）. CVP, PAWP and MPAP lowered significantly at T1 and T2 （P〈0. 01）. Serum levels of creatinine（Cr） and urea nitrogen（BUN） increased, while creatinine clearance rate（CCr） decreased. Urine output decreased in anhepatic period. Protein, occult blood and erythrocyte in urine increased significantly during operation. Conclusion Changes of ADM, ANP, ET, TXA2 and PGI2 in plasma were correlated with the changes of hemodynamics and renal glomerular filtration and barrier functions in the patients undergoing LT.