重症肝炎与非重症肝炎原位肝移植术中机体内环境的对比性研究  

A study to compare the changes of blood gas analysis during operation of orthotopic liver transplantation (OLT) between fulminant hepatic failure (FHF) and non-FHF

作　　者：陈駽鸣 陈杰[1] 应隽[1] 赵延华[1] 王祥瑞[1] 

机构地区：[1]上海第二医科大学附属仁济医院麻醉科,200127

出　　处：《实用医学杂志》2005年第16期1757-1759,共3页The Journal of Practical Medicine

摘　　要：目的:比较重症肝炎与非重症肝炎在原位肝移植术中血气、生化指标的变化。方法:26例晚期肝病患者,ASAⅢ～Ⅳ级,据病史、临床表现、肝功能等指标分成非重肝组(I,n=15)和重症肝炎组(Ⅱ,n=11),分别在术前、无肝前期、无肝期30、60min、新肝再灌注期5、30min、术毕抽取右侧桡动脉血进行血气分析,测定pH、BE、血Na+、K+、Cl-、Ca2+、葡萄糖、乳酸和HCO3-浓度,并记录患者术中碳酸氢钠、CaCl2、胰岛素的用量。结果:I组pH、BE、HCO3-从无肝期始明显降低,至再灌注5min时为最低,以后逐渐回升;K+浓度从无肝期始升高,至再灌注5min时为最高,以后逐渐下降;血糖、乳酸水平随手术的进行呈升高趋势,术毕时乳酸有所下降。Ⅱ组pH、BE、HCO3-从无肝期始明显降低,新肝期30min时逐渐回升;K+浓度从无肝期始升高,至再灌注30min时逐渐下降;血糖、乳酸水平随手术的进行呈升高趋势。组间比较,II组术前pH、BE、HCO3-明显高于I组,无肝期30min明显低于I组,无肝期60min、新肝再灌注期5min时pH、BE、HCO3-又明显高于I组;Ⅱ组血K+在再灌注期5min时明显高于I组。Ⅱ组血Ca2+在再灌注期5min时明显低于I组。术中Ⅱ组NaHCO3、CaCl2、RI的用量明显大于Ⅰ组。结论:Ⅱ组患者术中血生化指标变化明显大于I组,因此,根据血气变化予积极处理,是保障重症肝炎患者肝移植手术顺利进行的关键。Objective To compare the changes of blood gas analysis and electrolytes during operation of orthotopic liver transplantation （OLT） between fulminant hepatic failure （FHF） and non-FHF. Methods Twenty-six patients with end stage liver disease were divided into 2 groups ： non-FHF group（Ⅰ, n =15 ）, FHF group （Ⅱ, n=11）. Blood samples were drawn out from right radioartery to analyze blood gas and electrolytes at the time of pre-operation, preanhepatic period, 30, 60 min during anhepatic period, 5, 30 rain post-reperfosion, and the end of the operation. PH, BE and the concentration of Na^＋, K^＋, Cl^-, Ca^2＋, Glu, Lac and HCO^3- were recorded respectively. The amount of NaHCO3, CaCl2, RI during operation was recorded, Results pH, BE and HCO3^- levels were decreased significantly during anhepatic period and were lowest at 5min after reperfusion in group Ⅰ, concentration of K^＋ were increased gradually during anhepatic period and increased significantly at the time of reperfusion 5min, Glu and Lac levels were increased gradually during operation. The trend of changes of K^＋, Glu and Lac in group Ⅱ were similar to group Ⅰ, but the pH,BE and HCO3^- levels were higher significantly before operation, and they were decreased significantly at the period of anhapatic 30 min. K^＋ level in group Ⅱ was higher significantly than group I. On the contrary, Ca^2＋ level was lower at 5min after reperfusion. The larger dose of NaHCO3, CaCl2, RI were applied in group Ⅱ. The changes of blood gas analysis during the operation of OLT in group Ⅱ was larger than group Ⅰ. Conclusion It＇s the key to the patient with FHF that proper treatment should be applied according to the blood gas analysis.

关 键 词：重症肝炎 原位肝移植术 机体内环境 对比性研究 

分 类 号：R657.3[医药卫生—外科学]