探讨肝移植患者围手术期氧化应激对术后肺部并发症的影响。

本组前瞻性研究对象为2008年3月至2009年1月在中山大学附属第三医院行原位肝移植的35例患者。其中男30例，女5例；年龄24~65岁，中位年龄46岁。所有患者均签署知情同意书，符合医学伦理学规定。给予患者气管插管全身麻醉，调节呼吸参数维持呼气末CO₂分压为30~40 mm Hg（1 mm Hg=0.133 kPa）。术式均采用改良背驮式原位肝移植术。观察35例患者术后1个月内肺部并发症的发生情况。根据有否发生肺部并发症分为无肺部并发症组（无并发症组）和肺部并发症组（并发症组）。记录两组患者麻醉后（T1）、新肝开放1 h（T2）、新肝开放3 h（T3）、新肝开放24 h（T4）时间点的血清丙二醛（MDA）、超氧化物歧化酶（SOD）、总抗氧化能力（T-AOC）等氧化应激指标。两组患者术前临床资料的比较采用t检验或χ²检验，血清MDA、SOD、T-AOC的比较采用Wilcoxon秩和检验。

35例患者中23例（并发症组）出现肺部并发症，其中发生肺炎16例，肺不张1例，胸腔积液1例，气胸合并肺炎2例，肺炎合并胸腔积液3例，另12例（无并发症组）未发生肺部并发症。两组的术前临床资料比较差异均无统计学意义（P>0.05）。与无并发症组比较，并发症组患者的血清MDA在T2、T3时间点明显升高（Z=-2.190，-2.798；P<0.05），T-AOC在T4时间点明显升高（Z=-2.798，P<0.05），并发症组的围手术期血清MDA最大变化差异值明显增大（Z=-2.016，P<0.05）。另外，与无并发症组比较，并发症组患者的血清SOD在T2时间点明显降低（Z=-2.224，P<0.05），围手术期血清SOD最大变化差异值明显变小（Z=-2.120，P<0.05）。

移植围手术期机体氧化应激明显，氧化应激严重的患者可能更易发生术后早期肺部并发症。

To explore the impact of perioperative oxidative stress on pulmonary complications of patients who underwent orthotopic liver transplantation(OLT).

Thirty-five patients (30 males and 5 females with age ranging from 24 to 65 years old and median age of 46 years old) who underwent OLT from March 2008 to January 2009 in the Third Affiliated Hospital of Sun Yat-sen University were enrolled in this prospective study. The informed consents of all patients were obtained and the ethical committee approval was received. The patients were kept general anesthesia with tracheal intubation, and the breathing parameters were regulated to maintain the end-tidal CO₂ partial pressure at 30 to 40 mm Hg (1 mm Hg=0.133 kPa) . Modified piggyback OLT was performed on the patients. The incidence of pulmonary complications within 1 month after operation was observed. The patients were divided into 2 groups: the group without pulmonary complication (no-complication group) and the group with pulmonary complication (complication group) . Oxidative stress indexes such as serum malondialdehyde(MDA) level, superoxide dismutase(SOD) and the total antioxidant capacity(T-AOC) were recorded at the time point of post-anesthesia(T1), 1 h after liver reperfusion(T2), 3 h after reperfusion(T3) and 24 h after reperfusion (T4). Clinical data of patients in two groups were compared using t test or χ² test. Serum MDA level, SOD, T-AOC in two groups were compared using Wilcoxon rank sum test.

Twenty-three out of 35 patients in complication group suffered pulmonary complications after the operation, including 16 cases of pneumonia, 1 case of atelectasis, 1 case of pleural effusion, 2 cases of pneumothorax combined with pneumonia, and 3 cases of pneumonia combined with pleural effusion. No pulmonary complications were observed in 12 cases in no-complication group. There were no significant differences in the preoperative clinical data between two groups(P>0.05). Compared with no-complication group, the serum MDA level in complication group increased evidently at the time point of T2, T3(Z=-2.190,-2.798; P<0.05), T-AOC increased evidently at the time point of T4 (Z=-2.798, P<0.05) . The maximum variation value of perioperative serum MDA level in complication group increased significantly (Z=-2.016, P<0.05) . Besides, compared with no-complication group, the serum SOD level in complication group decreased evidently at the time point of T2 (Z=-2.224, P<0.05) . The maximum variation value of perioperative serum SOD level in complication group reduced significantly (Z=-2.120, P<0.05) .

The perioperative oxidative stress of OLT patients are obvious. Patients with severe oxidative stress may be more likely to suffer early pulmonary complications after OLT.