远端肢体缺血预处理对肝移植患者心脏的保护作用

Protective Effects of Remote Ischemic Preconditioning on the Hearts of Liver Transplantation Patients

摘要: 目的：研究远隔肢体缺血预处理(remote ischemic preconditioning, RIPC)对肝移植患者心脏的保护作用和价值。方法：67例择期在全麻下行经典原位肝移植患者，按照随机数字表法分为缺血预处理组(P组) 35例和对照组(C组) 32例。P组于手术开始10 min后行肢体缺血预处理：于左下肢根部绑止血带，以200 mmHg压力充气阻断下肢血流10 min，再放气恢复循环5 min，如此重复3次。C组于左下肢绑止血带40 min不进行充气放气操作。收集患者入室后(T₀)、切皮前(T₁)、下腔静脉阻断后5 min (T₂)、门静脉开放后5 min (T₃)、术毕(T₄)，检测mABP、HR、PAP、CI、SVR。检测各时点血清中cTnI、CK-MB和LDH含量。观察两组患者门静脉开放后发生恶性心律失常情况及术后情况。结果：T₃时P组患者CI、SVR明显高于C组，PAP明显低于C组(p < 0.05)，门静脉开放后即刻P组患者HR、mABP明显高于C组(p < 0.05)，门静脉开放后30 min和3~6 h P组患者cTnI、CK-MB明显低于C组(p < 0.05)术后机械通气时长P组明显少于C组(p < 0.05)而两组患者各时点LDH和门静脉开放即刻心律失常事件无明显差异(p > 0.05)。结论：远隔肢体缺血预处理对肝移植患者心脏有保护作用，减少心脏不良事件发生。

Abstract: Objective: To observe the protective effects and value of remote ischemic preconditioning on the hearts of liver transplantation patients. Methods: 67 patients underwent classical orthotopic liver transplantation were randomly divided into Remote-ischaemic preconditioning group (group P) in-cluding 35 patients and routine group (group C) including 32 patients according to random number table. Give group P remote ischemic preconditioning after 10 minutes of the operation beginning: Tie-up a tourniquet 10 min at the base of the left lower limb, block blood lower limb flow with 200 Hg pressure, then deflate 5 min to recover the circulating blood flow, repeat 3 times. Tie-up group C a tourniquet 40 minutes at the base of the left lower limb, don’t operate the inflation and deflation. Record the mABP, HR, PAP, CI, SVR after entering the room (T₀), before skin resection (T₁), inferior vena occlusion for 5 min (T₂), portal vein reperfusion for 5 min (T₃), and after operation (T₄), and the changes of myocardial enzymes (including cTnI, CK-MB and LDH) at any time. Observe the malig-nant arrhythmias occurring after portal vein reperfusion and postoperative condition. Results: Compared with Group-C, the CI and SVR in Group-P are higher (p < 0.05) and the PAP is lower at T₃, the HR and mABP are higher (p < 0.05) at portal vein reperfusion immediately, the cTnI and CK-MB are lower after portal vein reperfusion 30 min and 3~6 h (p < 0.05), the duration of postoperative mechanical ventilation is shorter (p < 0.05), but the LDH and the malignant arrhythmias occurring after portal vein reperfusion have no statistic difference (p > 0.05). Conclusion: Remote ischemic preconditioning can protect myocardium of liver transplantation patients and reduce adverse car-diac events.