重型肝炎和肝癌肝移植的麻醉管理  

Anesthetic management of patients with severe hepatitis and liver neoplasma during orthotopic liver transplantation*

作　　者：罗晨芳[1] 黑子清[1] 黎尚荣[1] 罗刚健[1] 甘小亮[1] 池信锦[1] 

机构地区：[1]中山大学附属第三医院麻醉科,广东广州510630

出　　处：《中国现代医学杂志》2006年第9期1372-1376,共5页China Journal of Modern Medicine

基　　金：国家自然科学基金资助项目(30271254);广东省科技计划项目(2004B35001005)

摘　　要：目的对重型肝炎和肝癌患者肝移植围术期的麻醉管理进行总结,为临床处理提供借鉴。方法回顾43例静吸复合全麻下因重型肝炎(A组)或肝癌(B组)施行改良背驮式肝移植术的麻醉管理,统计围术期血流动力学、出入量、酸碱电解质变化、凝血功能、凝血-抗纤溶药物及血管活性药物用量。结果两组病人血流动力学变化趋势一致,无肝期10min,新肝期10min血管活性药物用量两组差异无显著性(P>0.05);晶体液、白蛋白输入量B组多于A组,血小板输入量A组多于B组(P<0.05);红细胞输入量A组虽多于B组,但统计学上差异无显著性(P>0.05);术中各期经相应治疗,两组酸碱电解质的变化趋势相同;围术期clotrate、血小板计数、纤维蛋白原水平A组均低于B组(P<0.05),凝血酶原复合物和纤维蛋白用量A组大于B组,但统计学上差异无显著性(P>0.05);两组患者围术期凝血-纤溶系统功能的变化趋势大致相同。结论重型肝炎围术期凝血功能较肝癌患者差,术中需输注血小板量较多;围术期经过积极监测和及时处理,两组血流动力学、凝血-纤溶系统功能、酸碱电解质变化趋势基本相同。[Objective] To summarize the anesthetic management of patients with severe hepatitis and liver cancer during liver transplantation and supply references to clinical administration. [Methods] 43 severe hepatitis （group A） and liver cancer（group B） patients underwent liver transplantation under general anesthesia. Review these cases and make statistic of hemodynamics, requirements and loss of blood and liquid, acid-base and electrolyte, coagulate function, coagulant and anti-fibrinolytic drugs and vasoactive drugs. [Results] There was no significant difference in hemodynamic and the dose of vasoactive drugs used in 10 minutes after anhepatic and neoheptic. More liquid and albumin were needed in group B than group A, but the requirement of platelet in group B were more than group A （P 〈0.05）. RBC transfusion in group A was more than group B, but it had no statistic difference. The trend of changes in acid-base and electolyte were same in tow groups after treated. The clot rate, the platelet count, and the concentration of FIB of group A were less than those of group B during the operation （P 〈0.05）. The LPCC and fibriogen requirement in group A was more than group B, but it had no statistical difference （P 〉0.05）. The trend of changes in coagulant and fibrinolytic function were similar in two groups during the operation. [Conclusions] During liver transplantation, severe hepatitis patients have poorer coagulating function than patients with liver cancer and need more platelet. After treated, the trend of changes in hemodynamic, coagulant and fibrinolytic function.

关 键 词：重型肝炎 肝癌 肝移植 麻醉 凝血功能 

分 类 号：R735.7[医药卫生—肿瘤] R657.3[医药卫生—临床医学]