目的:探讨肝硬化患者肝移植围术期前列环素(PG I2)、血栓素(TXA2)的变化、在肝移植围术期的意义及对体、肺循环的影响。方法:24例终末期肝硬化患者接受改良背驮式肝移植术,监测围术期心率(HR)、平均动脉压(MABP)、平均肺动脉压(MPAP)、...目的:探讨肝硬化患者肝移植围术期前列环素(PG I2)、血栓素(TXA2)的变化、在肝移植围术期的意义及对体、肺循环的影响。方法:24例终末期肝硬化患者接受改良背驮式肝移植术,监测围术期心率(HR)、平均动脉压(MABP)、平均肺动脉压(MPAP)、中心静脉压(CVP)、肺动脉楔压(PAWP)、心指数(C I)、体循环阻力指数(SVR I)、肺循环阻力指数(PVR I)。分别于麻醉后术前、无肝前10 m in、无肝期30 m in、新肝期30 m in和术毕5个时点抽取中心静脉血,用放免法测定血浆TXB2及6-keto-PGF1α水平。结果:①MABP在下腔静脉和门静脉阻断及开放后短期内有一过性下降。②CVP、MPAP和PAWP在肝血管阻断后显著下降;供体肝脏复流后,显著升高。③C I在无肝期明显下降,新肝期10 m in后升高至较术前更高水平。④SVR I和PVR I在无肝期均显著增高;新肝期15 m in内SVR I和PVR I高于术前水平,新肝期30 m in后SVR I显著低于术前水平。⑤与术前值相比,6-keto-PGF1α和TXB2各期显著增加;与阻断前相比,6-keto-PGF1α在新肝期缓慢降低,在术毕时显著降低。结论:肝硬化患者肝移植围术期血浆TXA2、PG I2水平变化显著,一定程度影响了体肺循环。展开更多
INTRODUCTIONPortal hypertension is a common clinical syndromecharacterized by an abnormal increase in portalblood to the systemic circulation, bypassing theliver. Recent studies have reported that humoralsubstances pl...INTRODUCTIONPortal hypertension is a common clinical syndromecharacterized by an abnormal increase in portalblood to the systemic circulation, bypassing theliver. Recent studies have reported that humoralsubstances play an important role in thepathogenesis of portal hypertension, either byincreasing vascular resistance at both theintrahepatic and porto-collateral sites or affectingsplanchnic vasodilation with a concomitant increasein parto-collateral blood flow[1-6]展开更多
Portopulmonary hypertension(PPHTN)is a known complication of cirrhosis.Moderate-to-severe PPHTN implies an extremely poor prognosis.It occurs in 5%-10%of patients referred for liver transplantation(LT),and probably wi...Portopulmonary hypertension(PPHTN)is a known complication of cirrhosis.Moderate-to-severe PPHTN implies an extremely poor prognosis.It occurs in 5%-10%of patients referred for liver transplantation(LT),and probably with an higher incidence in patients with large portosystemic shunts.Patients with moderate-tosevere pulmonary hypertension have been previously excluded from LT because of the extremely high surgical risk and since the post-transplant outcome reported was poor.Recently,new perspectives in the management of patients with portopulmonary hypertension are emerging.In fact,some pulmonary vasoactive drugs have become routine in the treatment of patients with idiopathic pulmonary hypertension.These drugs,particularly epoprostenol,have been recently introduced in the treatment of patients with PPHTN,and have been shown to be effective in reducing pulmonary artery pressure as well as pulmonary vascular resistances.Furthermore,recent studies seem to demonstrate that treatment with pulmonary vasoactive drugs could allow liver transplantation with acceptable surgical risks and excellent survival.Although there are not large series nor prospective studies addressing this topic,the clinical scenario of patients with PPHTN seems to be positively changing.展开更多
文摘目的:探讨肝硬化患者肝移植围术期前列环素(PG I2)、血栓素(TXA2)的变化、在肝移植围术期的意义及对体、肺循环的影响。方法:24例终末期肝硬化患者接受改良背驮式肝移植术,监测围术期心率(HR)、平均动脉压(MABP)、平均肺动脉压(MPAP)、中心静脉压(CVP)、肺动脉楔压(PAWP)、心指数(C I)、体循环阻力指数(SVR I)、肺循环阻力指数(PVR I)。分别于麻醉后术前、无肝前10 m in、无肝期30 m in、新肝期30 m in和术毕5个时点抽取中心静脉血,用放免法测定血浆TXB2及6-keto-PGF1α水平。结果:①MABP在下腔静脉和门静脉阻断及开放后短期内有一过性下降。②CVP、MPAP和PAWP在肝血管阻断后显著下降;供体肝脏复流后,显著升高。③C I在无肝期明显下降,新肝期10 m in后升高至较术前更高水平。④SVR I和PVR I在无肝期均显著增高;新肝期15 m in内SVR I和PVR I高于术前水平,新肝期30 m in后SVR I显著低于术前水平。⑤与术前值相比,6-keto-PGF1α和TXB2各期显著增加;与阻断前相比,6-keto-PGF1α在新肝期缓慢降低,在术毕时显著降低。结论:肝硬化患者肝移植围术期血浆TXA2、PG I2水平变化显著,一定程度影响了体肺循环。
基金Project supported by the National Natural Science FoundationMinistry of Public Health of China, No. 37600481
文摘INTRODUCTIONPortal hypertension is a common clinical syndromecharacterized by an abnormal increase in portalblood to the systemic circulation, bypassing theliver. Recent studies have reported that humoralsubstances play an important role in thepathogenesis of portal hypertension, either byincreasing vascular resistance at both theintrahepatic and porto-collateral sites or affectingsplanchnic vasodilation with a concomitant increasein parto-collateral blood flow[1-6]
文摘Portopulmonary hypertension(PPHTN)is a known complication of cirrhosis.Moderate-to-severe PPHTN implies an extremely poor prognosis.It occurs in 5%-10%of patients referred for liver transplantation(LT),and probably with an higher incidence in patients with large portosystemic shunts.Patients with moderate-tosevere pulmonary hypertension have been previously excluded from LT because of the extremely high surgical risk and since the post-transplant outcome reported was poor.Recently,new perspectives in the management of patients with portopulmonary hypertension are emerging.In fact,some pulmonary vasoactive drugs have become routine in the treatment of patients with idiopathic pulmonary hypertension.These drugs,particularly epoprostenol,have been recently introduced in the treatment of patients with PPHTN,and have been shown to be effective in reducing pulmonary artery pressure as well as pulmonary vascular resistances.Furthermore,recent studies seem to demonstrate that treatment with pulmonary vasoactive drugs could allow liver transplantation with acceptable surgical risks and excellent survival.Although there are not large series nor prospective studies addressing this topic,the clinical scenario of patients with PPHTN seems to be positively changing.
