以氧供为导向的血流动力学管理模式对非转流下原位肝移植术机体氧代谢的影响  

The effects of oxygen delivery-directed hemodynamic management on oxygen metabolism during orthotropic liver transplantation without veno-venous bypass

作　　者：刘志武 赵晓玲 薄丰山 胡元威 马勇 季振鹏 

机构地区：[1]解放军第一〇七医院麻醉科,山东烟台264002

出　　处：《实用器官移植电子杂志》2013年第2期112-116,共5页Practical Journal of Organ Transplantation(Electronic Version)

摘　　要：目的观察以氧供(DO2)为导向的血流动力学管理模式在不同程度肝功能损害患者非转流经典原位肝移植手术过程中机体氧代谢变化。方法选择接受经典非转流肝移植术患者50例,按Pugh-Child评分法分为A级(A组,12例)、B级(B组,18例)、C级(C组,20例)。左桡动脉置管后常规麻醉诱导,经右颈内静脉放置Swan-Ganz导管。术中维持心排血指数(CI)>50ml/(s·m2),平均动脉压(MAP)≥60mm Hg(1mm Hg=0.133kPa)。分别在麻醉后手术前(T1),无肝期前10分钟(T2),无肝期30分钟(T3),新肝期30分钟(T4)及术毕(T5),采集桡动脉血和肺动脉的混合静脉血监测和计算以上各时点的动脉血氧饱和度(SaO2)、动脉血氧分压(PaO2)、混合静脉血氧饱和度(SO2)、CI、DO2、氧耗(VO2)及氧摄取率(ERO2)。结果 3组患者在T3时VO2、SO2和DO2均明显低于T1时(P<0.05或P<0.01)。3组VO2在T4时上升,明显高于T3时(均P<0.05),T5时恢复至T1时水平。B、C组的ERO2在T3时均明显高于T1时(均P<0.05)。T3时B、C组的SO2和DO2低于A组(均P<0.05),ERO2则明显高于A组(均P<0.05)。术后住院天数A、B、C组依次递增。结论以DO2为导向的血流动力学管理模式,对不同程度肝功能损害患者肝移植术中机体氧代谢整体变化趋势一致,均以无肝期异常最为严重。Pugh-Child分级B级和C级患者DO2和ERO2变化较A级患者更为剧烈。Objective To investigate the effects of oxygen delivery(DO2)-directed hemodynamic management on oxygen metabolism during orthotropic liver transplantation(OLT)without veno-venous bypass in the patients with different degrees of hepatic insufficiency. Methods 50 patients scheduled non veno-venous bypass OLT were divided into 3 groups according to the Pugh-Child scores ,class A(group A,12 patients),class B(group B,18 patients),class C(group C,20 patients). Left radial artery was cannulated before induction of anesthesia, then Swan-Ganz catheter was inserted in the pulmonary artery via right internal jugular vein. Cardiac index(CI)was maintained more than 50 ml/(s·m2)and mean arterial pressure more than 60 mm Hg(1 mm Hg=0.133 kPa)in all patients. Arterial partial pressure of oxygen(PaO2),mixed venous saturation(SvO2),CI,DO2,oxygen consumption (VO2)and oxygen extract rate(ERO2)were measured or calculated after anesthesia and before surgical incision(T1, baseline),at 10 minutes before anhepatic phase(T2),30 minutes after onset of anhepatic phase(T3),30 minutes after neohepatic phase(T4)and the end of surgical procedure(T5). Results In the three groups,VO2,SvO2, and DO2 during T3 showed substantial decrease in comparison with T1(P<0.05 or P<0.01),then VO2 markedly increased during T4 in comparison with T3(all P<0.05),which recovered to T1 up to the end of T5. ERO2 increased significantly during the T3 in comparison with T1 in group B and C(both P<0.05). Moreover,there were significant differences among three groups during T3,which mainly manifested the SvO2 and DO2 were much lower in group B and C than in group A, while ERO2 was much higher in group B and C than group A(all P<0.05). The length of hospital stay was increased sequentially from group A to group C. Conclusions The tendency of the whole changes in oxygen metabolism of the patients with different degrees hepatic insufficiency during OLT is consistent during DO2-directed management patterns of hemodynamics,and abnormality of oxygen metabolism occurs more sev

关 键 词：肝移植 氧代谢 Pugh-Child分级 

分 类 号：R657.3[医药卫生—外科学]