Catherine Paugam-Burtz, M.D., Souhayl Dahmani, M.D., Juliette Kavafyan, M.D., Jean Marty, M.D., Ph.D., Jean Mantz, M.D., Ph.D.
麻醉科，Beaujon医院，克里奇，法国

  原位肝移植（OLT）经常与再灌注综合征（RPS）有关联，特点是降低动脉压力。但是，与RPS发生有关的因素并没有完全弄清楚。本研究的目的是确定因肝硬化进行原位肝移植时，与RPS发生有关的因素。

材料和方法：3年内，我们前瞻性的研究了进行原位肝移植的肝硬化患者（pts），以下几类原位肝移植被排除在本次研究之外：急性肝功能衰竭、早期再次移植、肝-肾同步联合移植和活体原位肝移植。所有患者都根据行业协议进行了麻醉，并通过桡动脉导管和肺动脉导管进行实时监测。数据库的数据包括年龄、导致肝硬化的原因、CHILD分级、β-受体阻滞剂疗法、PCA法、移植肝冷缺血持续时间和血液动力学等。进行原位肝移植手术时保留了下腔静脉，或者没有使用PCA。在移植肝再灌注后的5分钟时间内，RPS 能使平均动脉压比基线值降低30%以上，且持续时间超过1分钟。(Anesth Analg 1997 ; 84 : 254-9)。

结果：本研究包括80名肝硬化患者，年龄为51±7岁（平均值±标准差），其中20名患者出现RPS。通过单变量分析得出，多种因素与RPS的发生有关，包括酒精性肝硬变、β-受体阻滞剂疗法、不使用PCA法、冷缺血持续时间、手术持续时间等。通过多变量分析，不使用PCA法（风险比OR[IC95%]: 5.46 [1.24-29.9]）和冷缺血时间（OR [IC95%]: 1.05 [1.001-1.008]）都是RPS的预测因子。

讨论：我们的研究结果证明并延伸了先前的发现，表明RPS的发生与不使用PCA有关系。有趣的是，我们的研究数据也第一次表明，因肝硬化进行原位肝移植的移植肝在进行血管重建术后，冷缺血时间是RPS的独立预测因素。

Duration of Cold Ischemia Is a Predictor of Reperfusion Syndrome during Liver Transplantation
Catherine Paugam-Burtz, M.D., Souhayl Dahmani, M.D., Juliette Kavafyan, M.D., Jean Marty, M.D., Ph.D., Jean Mantz, M.D., Ph.D.
Anesthesiology Department, Beaujon Hospital, Clichy, France

Orthtopic liver transplantation (OLT) is frequently associated with a reperfusion syndrome (RPS) characterized by a decrease in arterial pressure. However, factors associated with the occurrence of RPS are not fully understood. The aim of the study was to determine factors associated with occurence of RPS during OLT for cirrhosis.

Materials and methods: During a 3 years period, consecutive OLT performed in cirrhotic patients (pts) have been prospectively studied. Exclusion criteria were OLT for acute liver failure, early retransplantation, simultaneous kidney and liver transplantation and living-donor related OLT. All the patients were anesthetized according to our local protocol and monitored with radial and pulmonary artery catheters. The database included age, cause of cirrhosis, CHILD classification, beta-bloquers therapy, presence of temporary portocave anastomosis (PCA), duration of graft cold ischemia and hemodynamic data. OLT was performed with preservation of the inferior vena cava with or without temporary PCA. RPS was defined as a decrease of the mean arterial pressure of more than 30% of the baseline value for more than 1 min during the first 5 min after reperfusion of the graft. (Anesth Analg 1997 ; 84 : 254-9).

Results: 80 pts were included, age 51±7 years (mean±SD) . RPS occurred in 20 pts. In univariate analysis, factors associated with RPS were alcoholic cirrhosis, β-blockers therapy, absence of PCA, cold ischemia duration, duration of surgery. In multivariate analysis, absence of PCA (Odds Ratio (OR)[IC95%]: 5.46 [1.24-29.9]) and duration of cold ischemia (OR [IC95%]: 1.05 [1.001-1.008]) were predictors of RPS.

Discussion: Our results confirm and extend previous findings showing that absence of PCA is associated with RPS. Interestingly, our data suggest for the first time that duration of cold ischemia is an independant predicting factor of RPS after revascularisation of the grafted liver when OLT is performed for cirrhosis.

[责任编辑:刘 聪]