去甲肾上腺素在肝移植手术中的应用

雷志礼; 董 兰; 韩曙君; 宇 鹏; 宁新宇; 陈 晖

PDF(601 KB)

武警医学 ›› 2012, Vol. 23 ›› Issue (2) : 2-2.

论著

去甲肾上腺素在肝移植手术中的应用

雷志礼，董兰，韩曙君，宇鹏，宁新宇，陈晖

作者信息 +

Effect of norepinephrine in patients undergoing orthotopic liver transplantation

Author information +

文章历史 +

摘要

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。

Abstract

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（P＜0.05）. β₂-MG in group N was significantly lower than that in group D at T₂ (P<0.05). Compared with T₁, only CK increased significantly at T₃（P＜0.05）, so did all the enzymes at T_4-5（P＜0.05）. 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.

关键词

去甲肾上腺素 / 肝移植 / 血流动力学 / 肾功能 / 心肌酶

引用本文

EndNote

Ris (Procite)

Bibtex

导出引用

雷志礼;董兰;韩曙君;宇鹏;宁新宇;陈晖. 去甲肾上腺素在肝移植手术中的应用[J]. 武警医学. 2012, 23(2): 2-2

Effect of norepinephrine in patients undergoing orthotopic liver transplantation[J]. Medical Journal of the Chinese People Armed Police Forces. 2012, 23(2): 2-2

参考文献

［1］ Cronin R E,De Torrente A,Miller P D,et al.Pathogenic mechanisms in early norepinephrine-induced acute renal failure: functional and histological correlates of protection［J］. Kidney Int,1978,14:115-125.
[2] Cronin R E, Erickson A M,De Torrente A, et al. Norepinephrine-induced acute renal failure: a reversible ischemic model of acute renal failure［J］. Kidney Int,1978,14:187-190.
[3] Kelleher S P, Robinette J B, Conger J D. Sympathetic nervous system in the loss of autoregulation in acute renal failure［J］. Am J Physiol,1984,246:379-386.
[4] Conger J D.Vascular abnormalities in the maintenance of acute renal failure［J］. Circulatory Shock,1983,11:235-244.
[5] Chiuyt, Cheng C C, Lin N N, et al. High-dose norepinephrine induces disruption of myocardial extracellular matrix and left ventricular dilatation and dysfunction in a novel feline model［J］. J Chin Med Assoc, 2006, 69 (8) : 343-350.
[6] Fu zl, Feng Y B, Xu H X, et al. Role of norepinephrine in development of short term myocardial hibernation ［J］. Acta Pharmacol Sin, 2006, 27 (2) : 158-164.
[7] Jiang J P, Downing S E.Catecholamine cardiomyopathy: review and analysis of pathogenetic mechanisms［J］. Yale J Biol Med, 1990, 63 (6) : 581 - 591.
[8] Fu Y C, Chic S, Yin S C, et al. Norepinephrine induces apoptosis in neonatal rat endothelial cells via down - regulation of Bcl – 2 and activation of β - adrenergic and caspase - 2 pathways［J］.Cardiovasc Res, 2004, 61 (1) : 143 - 151.
[9] Deten A, Shibata J, Schol Z D, et al. Norepinephrine-induced acute heart failure in transgenic mice over expressing erythropoietin［J］. Cardiovasc Res, 2004, 61 (1): 105 - 114.
[10] Schaer G L, Fink M P, Parrillo J E. Norepinephrine alone versus norepinephrine plus low-dose dopamine: Enhanced renal blood flow with combination presser therapy［J］. Crit Care Med,1985,13(6):492-496.
[11] Anderson W P, Korner P I, Selig S E. Mechanisms involved in the renal responses to intravenous and renal artery infusions of noradrenaline in conscious dogs［J］. J Physiol,1981,321:21-30.
[12] Llinas M T, Lopez R, Rodriguez F, et al. Role of COX-2-derived metabolites in regulation of the renal hemodynamic response to norepinephrine［J］. Am J Physio,2001,281:975-982.
[13] Imig J D, Deichmann P C. Afferent arteriolar responses to ANG II involve activation of PLA2 and modulation by lipoxygenase and P-450 pathways［J］. Am J Physio, 1997,273:274-282.
[14] Martin C, Eon B,Saux P,et al. Renal effects of norepinephrine used to treat septic shock patients［J］.Crit Care Med,1990,18:282-285.
[15] 侯立朝,熊利泽,陈绍洋,等.去甲肾上腺素对感染性休克患者肾脏功能的影响［J］. 临床麻醉学杂志,2007,23(2):144-146.
[16] Anderson W P, Korner P I, Selig S E. Mechanisms involved in the renal responses to intravenous and renal artery infusions of noradrenaline in conscious dogs［J］. J Physiol,1981,321:21-30.
[17] 张利萍,杨路,候娟,等.多巴胺或多巴胺复合去甲肾上腺素对肝移植术中患者血液动力学、氧代谢及肾功能的影响［J］.中华麻醉学杂志,2006,26(3):217-220.
[18] 董刚,徐晨,刘振文,等.肝硬化患者肝移植围术期肾脏功能的保护［J］.实用医学杂志,2010,26(3):404-406.
[19] 杨进城,季锡清,李朝龙,等.肝缺血-再灌注损伤早期对其他脏器的影响［J］.第一军医大学学报,2004,24 (9) :1019 -1022.