| Objective: At present,liver transplantation has become the only effective treatment for end-stage liver disease,which is widely carried out in China.Severe hepatitis is a syndrome which body is under the action of various pathogenic factors,the liver cells appear large or sub-large necrosis leading to liver failure,and can be accompanied by kidney,brain,lung and other extrahepatic organ failure.Because of the severe perioperative hemodynamic fluctuations of liver transplant patients,it always has a huge impact on the heart,and produces poor prognosis.Remote ischemic preconditioning(RIPC)refers to the implementation of transient ischemic pre-stimulation in distant organs such as limbs,to improve the tolerance of other important target organs to subsequent fatal ischemic injury,and at the same time to protect important organs such as heart,brain,lung,kidney,etc.from ischemia-reperfusion damage,the application of pressurized tourniquets(or cuffs)after compression and then release to implement periodic ischemia pretreatment to achieve protective effect,the method is simple,viable,safe and non-invasive.This study aims to investigate the protective effect of remote ischemic preconditioning(RIPC)on the heart of liver transplantation(LA)patients,and to provide a basis for perioperative safety guidance of liver transplantation.Methods: 67 patients underwent classical orthotopic liver transplantation were randomly divided into Remote-ischaemic preconditioning group(group P)including 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 3times.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 m ABP,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 c Tn I,CK-MB and LDH)at any time.Observe the change of the average arterial pressure,heart rate and malignant arrhythmias(ventricular fibrillation,ventricular tachycardia,sinus tachycardia,supraventricular tachycardia,atrial fibrillation,sinus bradycardia,cardiac arrest,etc.)occurred after portal vein reperfusion as well as postoperative ICU hospitalization and the occurrence of lower limb adverse reactions in group P.Results: Compared with Group-C,the CI and SVR in Group-P are higher(P<.05)and the PAP is lower at T3,the HR and m ABP are higher(P<.05)at portal vein reperfusion immediately,the c Tn I and CK-MB are lower after portal vein reperfusion 30 min and 3-6h(P<.05),the duration of postoperative mechanical ventilation is shorter(P<.05),but the LDH and the malignant arrhythmias occurred after portal vein reperfusion have no statistic difference(P>.05).Conclusion: The results of this study prove that remote ischemic preconditioning(RIPC)has protective significance for the heart of liver transplant patients in classical orthotopic liver transplantation,which can reduce the sharp fluctuation of perioperative hemodynamics,reduce the growth range of myocardial enzymes,and reduce the poor prognosis,which has certain clinical value. |
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