非转流经典原位肝移植术中血气和电解质的变化  

Changes in arterial blood gas and electrolytes during non-bypass orthotopic liver transplantation

作　　者：李士通[1] 汪正平[1] 王莹恬[1] 徐国辉[1] 颜涛[1] 庄心良[1] 

机构地区：[1]交通大学附属上海市第一人民医院麻醉科,上海200080

出　　处：《上海医学》2004年第11期817-820,共4页Shanghai Medical Journal

基　　金：上海市临床医学中心资助项目 (ZX0 1A0 6)

摘　　要：目的　探讨非转流经典原位肝移植术中患者动脉血气、电解质的变化及其原因。方法　 80例行非转流经典原位肝移植患者 ,采用气管内插管静吸复合麻醉。除监测血流动力学外 ,同时于麻醉前、无肝前期、无肝期 30min和 6 0min、移植肝门静脉和腔静脉开放 5min和 30min、手术结束时监测动脉血气及电解质 ,其中70例采集门静脉开放后的肝静脉血进行测定。并对血流动力学和代谢紊乱进行纠正。结果　手术期间循环系统变化明显 ,腔静脉阻断期间血压下降、心率增快 ,门静脉开放后低血压 ,5 7例患者需应用血管活性药物。动脉血 pH于无肝期 30min开始下降 ,至术终恢复 ;二氧化碳分压 (PaCO2 )于下腔静脉开放后 5min平均升高约 4～ 5mmHg(1mmHg =0 .133kPa)。剩余碱 (BE)平均值于无肝期下降 ,开放后个体间差值明显加大 ,为 - 13～ +9;血钾开放后 5min时个体间波动在 2 .6～ 6 .1mmol/L ;血钙于麻醉后至开放后 30min均降低 ,术终有所恢复。血钠基本保持平稳。开放后肝静脉血严重高钾、高CO2 ,而钠、钙、pH和BE显著降低。结论　非转流原位肝移植无肝期前 ,经适当调控内环境保持相对较稳定 ,门静脉和下腔静脉开放后出现明显循环波动和内环境紊乱 ,显著低钙、高CO2 。Objective To investigate the changes of arterial blood gas (ABG) and electrolytes as well as the effects of hepatic venous blood after reperfusion on these changes during orthotopic liver transplantation (OLT) without anhepatic veno-venous bypass. Methods Eighty OLT for end-stage liver disease were performed under general anesthesia with continuously monitoring of hemodynamics. ABG and electrolytes were also measured before anesthesia, before cross-clamping of the portal vein, 30 min and 60 min in anhepatic phase, 5 min and 30 min after unclamping of portal vein and at the end of the operation. In addition, hepatic venous blood samples were also collected and analysed after portal vein reperfusion in 70 of the 80 patients. The disturbances in hemodynamics and blood gas or electrolytes were corrected according to the measurements. Results There were significant changes in hemodynamics during the operation. MAP decreased and HR increased during anhepatic period, especially in clamping and unclamping the portal vein and vena cava. The blood pressure in 57 patients were supported with vasoconstricter. Arterial pH declined after 30 min of anhepatic phase. 5 min after reperfusion PaCO 2 increased 4～5 mm Hg in average. BE decreased after clamping of the portal vein. Serum potassium level and BE had greater individual differences, with 2.6～6.1 mmol/L of potassium level and -13～+9 of BE respectively. Hypocalcemia occurred during the operation. Serum sodium was maintained stably. There were tremendous increases in potassium, PCO 2, and severe decreases in sodium, calcium, pH and BE in hepatic vein blood samples. Conclusion In orthotopic liver transplantation without veno-venous bypass, the hemodynamics and homeostasis were seriously disturbed by clamping and unclamping the portal vein and inferior vena cava. (Shanghai Med J, 2004,27∶817-820)

关 键 词：非转流 原位肝移植术 肝门静脉 术中 患者 肝静脉 动脉血气 调控 CO2 变化 

分 类 号：R657.3[医药卫生—外科学] R614[医药卫生—临床医学]