Department of Anesthesiology and Pain Medicine, Boramae Medical Center, Seoul, Korea.
Am J Transplant. 2011 May;11(5):977-83. doi: 10.1111/j.1600-6143.2011.03514.x.
Postreperfusion syndrome (PRS), an acute decrease in blood pressure after reperfusion of the liver graft, occurs frequently during liver transplantation surgery. We supposed that the activation of the kallikrein-kinin system leading to extensive systemic vasodilatation was a possible cause. The effect of pretreatment with nafamostat mesilate (NM), a broad spectrum serine protease inhibitor, on the occurrence of PRS was evaluated. Sixty-two adult liver recipients were randomized to receive an intravenous bolus of either 0.02 mg/kg of NM (NM group, n = 31) or an equal volume of normal saline (control group, n = 31) just before reperfusion of the liver graft. Occurrence of PRS and intraoperative use of vasoactive drugs were compared between the two groups. Postoperative recovery was also compared. PRS was significantly less frequent (48% vs. 81%, p = 0.016) requiring less vasopressors in the NM group compared to the control group. The NM group also showed faster recovery of the mean arterial pressure. Perioperative laboratory values were similar between the two groups. Pretreatment with 0.02 mg/kg of NM immediately before reperfusion decreases the frequency of PRS and vasopressor requirements during the reperfusion period in liver transplantation.
再灌注后综合征（PRS）是肝移植手术中肝再灌注后血压急性下降的一种常见并发症。我们推测，激肽释放酶-激肽系统的激活导致广泛的全身血管扩张可能是其原因之一。本研究旨在评估预先给予氨甲环酸（NM），一种广谱丝氨酸蛋白酶抑制剂，对 PRS 发生的影响。
将 62 例成年肝移植受者随机分为 NM 组（n = 31）和对照组（n = 31），NM 组在肝再灌注前静脉推注 0.02mg/kg NM，对照组给予等容量生理盐水。比较两组 PRS 的发生情况和术中血管活性药物的使用情况，并比较术后恢复情况。
与对照组相比，NM 组 PRS 的发生率显著降低（48% vs. 81%，p = 0.016），需要的升压药也更少。NM 组的平均动脉压恢复也更快。两组围手术期实验室指标无差异。
肝移植前给予 0.02mg/kg NM 预处理可降低再灌注期间 PRS 的发生率和升压药的需求。
