非转流下原位肝移植术中患者氧代谢的变化  

Changes in oxygen metabolism during orthotopic liver transplantation without veno-venous bypass

作　　者：黄素琴[1] 祝胜美[1] 吴健[1] 何慧梁[1] 陈益忠[1] 冯智英[1] 陈庆廉[1] 

机构地区：[1]浙江大学医学院附属第一医院麻醉科,杭州市310003

出　　处：《中华麻醉学杂志》2004年第11期816-819,共4页Chinese Journal of Anesthesiology

摘　　要：目的 观察非转流下原位肝移植术中患者氧代谢的变化。方法 21例拟行原位肝移植术的终末期肝病患者,采用静吸复合全身麻醉,无肝期不接受体外转流。麻醉前行双侧桡动脉穿刺置管以备采动脉血和监测动压脉,经右颈内静脉放置Swan-Ganz导管测中心静脉压(CVP)、肺动脉平均压(PAP)、肺毛细血管嵌锲压(PCWP),麻醉诱导后经鼻向胃内置入14F TRIP-NGS导管,监测胃粘膜二氧化碳分压(PgCO2)。分别于全麻诱导后30 min(T0)、门静脉阻断即刻(T1)、门静脉开放后5 min(T2)、门静脉开放后90min(T3)和关腹时(T4)用热稀释法测定心输出量(CO),计算心脏指数(CI)、心搏量指数(SVI)、外周血管总阻力指数(SVRI)、肺血管总阻力指数(PVRI),同时取桡动脉血和肺动脉血作血气分析,记录血液动力学指标、PgCO2,计算氧供(DO2)、氧耗(VO2)、氧供指数(DO2I)、氧耗指数(VO2I)、氧摄取率(ERO2)、胃粘膜内pH值(pHi)、胃粘膜及动脉血二氧化碳分压差(Pg-aCO2)。结果与T0比较,T1-4时心率增快(P<0 01),T1时MAP、CVP、PCWP、PAP、CO、CI和SVI下降,SVRI升高(P<0.05或0.01),T2时PAP、PCWP、CO、CI上升(P<0.05),T3时MAP、SVI下降(P<0.05),T1时DO2、DO2I下降,ERO2增高(P<0.01),T4时VO2、VO2I增加(P<0.05),T1-4时pHi下降(P<0.01),T1和T2时PgCO2。Objective To investigate the changes in oxygen metabolism during orthotopic liver transplantation (OLR) without veno-venous bypass since dramatic circulatory changes may take place during operation.Methods Twenty-one patients with end-stage liver disease (18 males, 3 females) aged 20-61 yrs weighing 44-86 kg undergoing OLT without veno-venous bypass under general anesthesia were enrolled in this study. S-G catheter was placed in the pulmonary artery via right internal jugular vein and both right and left radial artery were cannulated. ECG, SpO2 , PETCO2 and naso-pharyngeal temperature were continuously monitored during surgery. Anesthesia was induced with midazolam 0.1 mg·kg-1 , etomidate 0.2-0.3 mg·kg-1, fentanyl 5-10 μg·kg-1 and vecuronium 0.08-0.1 mg·kg-1 . After tracheal intubation anesthesia was maintained with isoflurane inhalation (0.5%-1.0%) and continuous infusion of propofol at 2-4 mg·kg-1·h-1 supplemented with intermittent i.v. boluses of midazolam, fentanyl and vecuronium. A 14F naso-gastric TRIP-NGS tube was inserted in the stomach for measurement of gastric mucosal pH (pHi). Blood samples were taken from radial and pulmonary artery for blood gas analysis. Hemodynamic parameters, blood gases (arterial and mixed venous) and PgCO2 were recorded and oxygen delivery (DO2) , oxygen consumption (VO2) and pHi were calculated at 30 min after induction (T0, baseline), when inferior vena cava and portal vein were clamped (T1) , 5 min after unclamping of inferior vena cava and portal vein (T2) , 90 min after graft reperfusion (T3) and at the end of operation (T4) . Results DO2 was significantly decreased at T1 while VO2 was significantly increased at T4 compared to baseline (T0) (P <0.01 or 0.05). PgCO2 and Pg-aCO2 were both significantly increased at T1-2 and pHi and pHa wereboth significantly decreased at T1-4 compared to baseline (P < 0.05 or 0.01) .Conclusion There are significant changes in oxygen metabolism and gastric mucosal pH during OLT without veno-venous bypass and hemodynamic monitoring is m

关 键 词：原位肝移植术 患者 非转流 氧代谢 术中 门静脉 PAP VO2 结论 开放 

分 类 号：R657.3[医药卫生—外科学]