摘要
目的评价脂微球化前列地尔对原位肝移植术患者肺损伤的影响。方法选择择期原位肝移植术患者48例，年龄45～64岁，ASA分级Ⅱ-Ⅳ级，体重45～70kg，性别不限，采用随机数字表法，将其分为2组（n=24）：对照组（C组）和脂微球化前列地尔组（A组）。A组分别于麻醉诱导前和新肝期1h时缓慢静脉输注（输注时间30min）脂微球化前列地尔5μg（生理盐水稀释至10m1）；C组术中未使用脂微球化前列地尔。于术前即刻（T1）、术毕（T2）、术后24h（T3）时记录气道峰压（PIP）、平均气道压（Pmean）、肺动态顺应性（cd）、氧合指数（OI）、呼吸指数（RI）、呼出气冷凝液中炎性因子的浓度。记录术后7d内肺部并发症的发生情况。结果与C组比较，A组T2，3时PIP、Pmean、RI、呼出气冷凝液中TNF—α、IL-8浓度均降低，Cd和OI升高，术后7d内急性肺损伤和肺部感染发生率降低（P〈0．05），其余指标差异无统计学意义（P〉0．05）。结论脂微球化前列地尔对原位肝移植术患者具有肺保护作用。
Objective To evaluate the effect of lipo-alprostadil on lung injury in patients undergoing or- thotopic liver transplantation. Methods Forty-eight ASA Ⅱ -Ⅳ patients of both sexes, aged 45-64 yr, weighing 45-70 kg, scheduled for elective orthotopic liver transplantation, were randomly assigned to one of 2 groups （ n = 24 each）： control group （group C） and lipo-alprostadil group （group A）. Anesthesia was induced with midazo- lam, propofol, fentanyl and vecuronium and maintained with sevoflurane, sufentanil and vecuronium. The patients were tracheal intubated and mechanically ventilated. Lipo-alprostadil 5 μg in 10 ml of normal saline was infused in- travenously and slowly over 30 min before induction of anesthesia and at 1 h of neohepatic phase in group A. Lipo- alprostadil was not administrated in group C. Peak inspiratory pressure （PIP）, mean inspiratory pressure （Pmean）, dynamic lung compliance （Cd）, oxygenation index （OI）, respiratory index （RI） and the concentrations of inflammatory cytokines in exhaled breath condensate （EBC） were recorded immediately before operation, at the end of operation, and at 24 h after operation. The occurrence of pulmonary complications was recorded within 7 days after operation,Results Compared with group C, PIP, Pmean, RI, and TNF-α and IL-8 concentrations in EBC were significantly decreased, while Cd and OI were increased at the end of operation and 24 h after operation, and the incidence of acute lung injury and pulmonary infection were decreased within 7 days after operation （ P 〈 0.05） , and no significant change in the other indexes was found in group A （ P 〉 0.05 ） . Conclusion Lipo-alprostadil has protective effect on lung in patients undergoing orthotopic liver transplantation.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2013年第3期338-341,共4页
Chinese Journal of Anesthesiology
基金
基金项目：广东省科技计划项目（20118031800058）
广东省医学科研基金（A2009197）
贝朗麻醉科学研究基金（201IZIOE）
关键词
前列地尔
脂质体
肝移植
呼吸窘迫综合征
成人
Alprostadil
Liposomes
Liver transplantation
Respiratory distress syndrome, adult
