磷酸肌酸钠对活体肝移植术患者围术期心肌损伤的影响

Effect of creatine phosphate on perioperative myocardial injury caused by living donor liver transplantation in adult patients

目的 评价磷酸肌酸钠对活体肝移植术患者围术期心肌损伤的影响。方法活体肝移植术患者40例，ASA分级Ⅱ～Ⅳ级，肝功能Child—Pugh分级B或c级，年龄45～62岁，体重47-91k，随机分为2组：对照组（c组）和磷酸肌酸钠组（cP组），每组20例。cp组切皮时静脉注射磷酸肌酸钠30mg／kg，继以4mg·kg^-1·h^-1的速率静脉输注至术毕；C组静脉输注等容量生理盐水。分别于切皮前即刻、无肝期5、30min、新肝期5、30min和术毕时，记录HR、MAP、CVP、肺动脉毛细血管楔压、CO和SvO2。于切皮前即刻、无肝期30min、新肝期30min、术毕、术后4和24h时，采集中心静脉血样，测定血清心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）的浓度和乳酸脱氢酶（LDH）活性。记录术后不良事件的发生情况。结果与切皮前即刻比较，两组新肝期30min至术后24h时血清cTnI、CK—MB的浓度和LDH活性升高（P〈0．05或0．01）。与c组比较，CP组新肝期5min至术毕时MAP和CO升高，新肝期30rain至术后24h时血清cTnI、CK-MB的浓度和LDH活性降低，室性心律失常发生率降低（P〈0．05或0．01）。结论磷酸肌酸钠可减轻活体肝移植术患者围术期心肌损伤的程度。

Objective To investigate the effect of creatine phosphate on perioperative myocardial injury caused by living donor liver transplantation （LDLT） in adult patients. Methods Forty ASA Ⅱ -Ⅳ patients （liver function Child-Pugh grade B or C） aged 45-62 yr weighing 47-91 kg undergoing LDLT were randomly divided into 2 groups （ n = 20 each） ： control group （group C） and creatine phosphate group （group CP）. In group CP, creatine phosphate 30 mg/kg was injected intravenously at skin incision followed by creatine phosphate infusion at 4 mg· kg^-1·h ^-1 until the end of surgery. In group C, equal volume of normal saline was infused instead of ereatine phosphate. HR, MAP, CVP, PCWP, CO and SvO2 were recorded immediately before skin incision, at 5 and 30 min of anhepatic phase, at 5 and 30 min of neohepatic phase and at the end of operation. Blood samples were taken from central vein immediately before skin incision （baseline, To ）, at 30 min of anhepatic phase （T1）, at 30 min of neohepatic phase （T2）, at the end of operation （T3） and at 4 and 24 h after operation （T4.5） for determination of serum cardiac troponin I （cTnI） and creatine kinase MB （CK-MB） concentrations and lactate dehydrogenase （LDH） activity. Postoperative adverse events were recorded. Results The serum cTnI and CK-MB concentrations and LDH activity were significantly increased at T2-5 as compared with the baseline value at TO in both groups （ P 〈 0.05 or 0.01 ）. MAP and CO were significantly higher from 5 vain of neohepatie phase to the end of operation, the serum cTnI and CK-MB concentrations and LDH activity were significantly lower at T2,5 , and the incidence of ventricular arrhythmia was significantly lower in group CP than in group C （ P 〈 0.05 or 0.01 ）. Conclusion Creatine phosphate can attenuate perioperative myocardial injury caused by LDLT in adult patients.