去甲肾上腺素在肝移植手术中的应用

目的 探讨去甲肾上腺素(NE)在肝移植手术中应用的可行性及对心、肾功能的影响.方法 择期行经典非转流原位肝移植术的晚期肝硬化40例,随机分为去甲肾上腺素组(N组)和多巴胺组(D组),术中分别持续输注NE和多巴胺,两组分别于切皮前(T1)、切皮后1 h(T2)、无肝期30 min(T3)、新肝期1 h(T4)及新肝期4 h(T5)监测血流动力学指标、肾功能和心肌酶.结果 两组各时点MAP均维持在目标范围内;T3时,N组MAP高于D组,心率(HR)低于D组(P＜0.05);T2时β2-MG N组明显低于D组(P＜0.05).T3时两组患者血清CK浓度升高(P＜0.05);T4～5时各心肌酶值均显著升高(P＜0.05).结论 晚期肝硬化患者行肝移植手术,NE能较好地维持血液动力学稳定且对心率影响较小,而且未见NE对肾功能和心肌酶有不利影响.

Effect of norepinephrine in patients undergoing orthotopic liver transplantation

Objective To evaluate the effect of norepinephrine on hemodynamic,renal function and myocardial enzymes in patients undergoing orthotopic liver transplantation.Methods Forty adult patients undergoing orthotopic liver transplantation were randomly divided into two groups： norepinephrine group（group N） and dopamine group（group D）（n=20）.Hemodynamic variables,renal function and myocardial enzymes were measured respectively just before incision（T1）,at 1 h after incision（T2）,30 min after the clamping of the portal vein（T3）,1 h（T4） and 4 h（T5） after the unclamping of the portal vein.Results Mean arterial pressure（MAP） was maintained to the target in both groups during the operation.Group N showed high MAP and low heart rate（HR） at T3,compared with group D（P0.05）.β2-MG in group N was significantly lower than that in group D at T2（P0.05）.Compared with T1,only CK increased significantly at T3（P0.05）,so did all the enzymes at T4-5（P0.05）.Conclusions Norepinephrine can maintain hemodynamic stability with low HR in patients undergoing orthotopic liver transplantation,without any deleterious effects on renal function and myocardial enzymes.