Sako Hidenori, Hadama Tetsuo, Miyamoto Shinji, Anai Hirofumi, Wada Tomoyuki, Iwata Eriko, Hamamoto Hirotsugu, Tanaka Hideyuki, Urushino Keiko, Shuto Takashi
Department of Cardiovascular Surgery, Oita University, School of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan.
Surg Today. 2006;36(2):140-6. doi: 10.1007/s00595-005-3116-2.
Abdominal aortic aneurysm (AAA) surgery subjects the lower extremities to ischemia and reperfusion. Although it is not extensive or prolonged, ischemia of the lower extremities during aortic cross-clamping is gradually and steadily induced. We studied the effects of prostaglandin E1 (PGE1) on ischemia-reperfusion injury of the lower extremities during AAA repair.
During AAA surgery, two near-infrared spectroscopy probes were positioned on each calf muscle to monitor oxygen metabolism in the lower extremities. We also measured lactate concentration in both iliac veins.
Near-infrared spectroscopy signals responded sensitively to aortic cross-clamping and declamping. Lactate increased time-dependently during aortic cross-clamping. The continuous venous administration of PGE1 (20 ng/kg per minute) inhibited the accumulation of lactate during aortic cross-clamping. Declamping of the first iliac artery resulted in a further but transient increase in ipsilateral venous lactate, which may be one component in the mechanism of declamping shock. Prostaglandin E1 eliminated the transient increase in ipsilateral lactate. The administration of PGE1 inhibited the contralateral accumulation of lactate after first declamping, and the lactate level decreased gradually before the second declamping.
Prostaglandin E1 seems to have a protective effect against ischemia-reperfusion injury of the lower extremities during AAA surgery.
腹主动脉瘤（AAA）手术会使下肢遭受缺血和再灌注。尽管这种缺血范围不广且持续时间不长，但在主动脉交叉钳夹期间下肢缺血是逐渐且稳定地发生的。我们研究了前列腺素E1（PGE1）对AAA修复过程中下肢缺血再灌注损伤的影响。
在AAA手术期间，将两个近红外光谱探头置于每块小腿肌肉上，以监测下肢的氧代谢。我们还测量了双侧髂静脉中的乳酸浓度。
近红外光谱信号对主动脉交叉钳夹和松开反应敏感。在主动脉交叉钳夹期间，乳酸随时间依赖性增加。持续静脉输注PGE1（每分钟20 ng/kg）可抑制主动脉交叉钳夹期间乳酸的蓄积。第一根髂动脉松开导致同侧静脉乳酸进一步但短暂增加，这可能是松开休克机制的一个组成部分。前列腺素E1消除了同侧乳酸的短暂增加。PGE1的输注抑制了首次松开后对侧乳酸的蓄积，并且在第二次松开前乳酸水平逐渐下降。
前列腺素E1似乎对AAA手术期间下肢的缺血再灌注损伤具有保护作用。
