The relation between the elevation of inflammatory mediators release and myocardial dysfunction after ischemia-reperfusion following Pringle's maneuver

肝切除术与心脏不良事件的高发生率相关。术前有心脏疾病的患者在肝切除术后早期的术后发病率和死亡率增加。虽然Pringle手法（在肝十二指肠韧带处完全阻断肝血管）已被广泛采用以减少肝实质剥离时的出血，但它引起了严重的肝缺血，这被认为是潜在的危险，特别是对缺血性肝。此外，普林格尔动作后的缺血-再灌注损伤导致炎症通路的激活，导致对远端器官如心肌、肺和肾的损伤，其最初可能功能障碍并最终衰竭。最近，促炎细胞因子已被牵连在介导心肌功能障碍。肝切除术联合Pringle's手法与一过性严重炎症反应有关，包括促炎细胞因子的释放，并导致全身炎症，可能伴有苦参碱诱导的心肌心室功能障碍。尤其是舒张功能的组织多普勒成像（TDI）以及这种改变是否与全身反应有关，所述全身反应的特征是在接受部分化疗的患者中炎性介质水平增加。在本研究中，心肌运动速度的变化，通过使用TDI推导出左心室收缩和舒张功能的损害后，第一次和最后一次Pringle的动作。手术结束时，收缩功能恢复到术前状态，而舒张功能仍然恶化。此外，末次Pringle's动作后LVEF、Sa的变化与IL-6水平显著相关。

Hepatic resection is associated with a high incidence of adverse cardiac events. Patients with preoperative cardiac conditions appear to be at increased risk of early postoperative morbidity and mortality after hepatic resection. Although, Pringle's maneuver, total occulusion of the liver vasculature at the hepatoduodenal ligament, has been widely adopted to reduce bleeding during liver parenchymal dissection, it induced profound hepatic ischemia, which is considered to be potentially dangerous, especially to cirrhotic liver. In addition, ischemia-reperfusion injury following Pringle's maneuver leads to activation of inflammatory pathways, resulting in injury to distant organs such as the myocardium, lung, and kidney, which may initially dysfunction and eventually fail. Recently, proinflammatory cytokines have been implicated in mediating myocardial dysfunction. Hepatic resection with Pringle's maneuver is associated with a transient severe inflammatory response involving the release of proinflammatory cytokines and leads to systemic inflammation, which may be accompanied by cytokine-induced myocardial ventricular dysfunction.The aim of this study is to evaluate the perioperative alteration of myocardial, especially diastolic function by Tissue Doppler imaging (TDI) and whether this alteration is associated with a systemic response characterized by increased levels of inflammatory mediators in patients undergoing partial hepatectomy with Pringle's maneuver.In the present study, changes in myocardial velocities derived by using TDI indicated impairment in left ventricular systolic and diastolic performance after the first and last Pringle's maneuver. At the end of surgery, the systolic function returned to preoperative status, whereas the diastolic function remained deteriorated. In addition, the changes of LVEF and Sa were significantly correlated with the level of IL-6 after the last Pringle's maneuver.