Choukèr A, Schachtner T, Schauer R, Dugas M, Löhe F, Martignoni A, Pollwein B, Niklas M, Rau H G, Jauch K W, Peter K, Thiel M
Clinic of Anaesthesiology, Klinikum Grosshadern, Ludwig-Maximilians-University, D-81377 Munich, Germany.
Br J Anaesth. 2004 Aug;93(2):204-11. doi: 10.1093/bja/aeh195. Epub 2004 Jun 11.
The Pringle manoeuvre and ischaemic preconditioning are applied to prevent blood loss and ischaemia-reperfusion injury, respectively, during liver surgery. In this prospective clinical trial we report on the intraoperative haemodynamic effects of the Pringle manoeuvre alone or in combination with ischaemic preconditioning.
Patients (n=68) were assigned randomly to three groups: (i) resection with the Pringle manoeuvre; (ii) with ischaemic preconditioning before the Pringle manoeuvre for resection; (iii) without pedicle clamping.
Following the Pringle manoeuvre the mean arterial pressure increased transiently, but significantly decreased after unclamping as a result of peripheral vasodilation. Ischaemic preconditioning improved cardiovascular stability by lowering the need for catecholamines after liver reperfusion without affecting the blood sparing benefits of the Pringle manoeuvre. In addition, ischaemic preconditioning protected against reperfusion-induced tissue injury.
Ischaemic preconditioning provides both better intraoperative haemodynamic stability and anti-ischaemic effects thereby allowing us to take full advantage of blood loss reduction by the Pringle manoeuvre.
在肝脏手术中，分别应用普林格尔手法和缺血预处理来预防失血和缺血再灌注损伤。在这项前瞻性临床试验中，我们报告了单独使用普林格尔手法或联合缺血预处理的术中血流动力学效应。
将68例患者随机分为三组：（i）采用普林格尔手法进行肝切除术；（ii）在采用普林格尔手法进行肝切除术之前进行缺血预处理；（iii）不进行肝门阻断。
普林格尔手法实施后平均动脉压短暂升高，但松开阻断后由于外周血管扩张而显著降低。缺血预处理通过降低肝脏再灌注后对儿茶酚胺的需求来改善心血管稳定性，而不影响普林格尔手法的减少失血的益处。此外，缺血预处理可防止再灌注引起的组织损伤。
缺血预处理可提供更好的术中血流动力学稳定性和抗缺血作用，从而使我们能够充分利用普林格尔手法减少失血的优势。
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