儿童肝移植术的麻醉处理  

Anesthetic management for liver transplantation in children

作　　者：李雅兰[1] 彭雪梅[1] Claudia D．spies 王仲红[1] 

机构地区：[1]暨南大学附属第一医院麻醉科,广州市510630 [2]Department of Anesthesiology, Charite Hospital Germany

出　　处：《中华麻醉学杂志》2007年第7期629-631,共3页Chinese Journal of Anesthesiology

摘　　要：回顾总结2006年1月至2006年9月在德国Charite医院12例儿童肝移植术的麻醉处理特点。12例ASAⅢ或Ⅳ级择期肝移植术患儿，入手术室后面罩给氧、吸入七氟醚，开放右前臂静脉通道；静脉注射咪达唑仑0．1—0．15mg／kg、异丙酚2—3mg／kg、芬太尼2—5μg／kg和罗库溴铵1—1．2mg／kg麻醉诱导；间断静脉注射芬太尼1—3μg／kg、罗库溴铵0．2—0．3mg／kg、吸入1％-1．5％异氟醚及静脉输注异丙酚4—6mg·kg^-1·h^-1维持麻醉。静脉输注多巴胺1—5μg·kg^-1·min^-1、硝酸甘油0．2—0．4μg·kg^-1·min^-1、去甲肾上腺素、肾上腺素0．01—0．04μg·kg^-1·min^-1或静脉注射去氧肾上腺素40-100μg或肾上腺素10-40μg维持循环稳定。术中采用加温床、加热毯和加温输液仪等进行保温处理。下腔静脉阻断时间为60-140min，手术时间为420—610min。术中监测心率、心电图、脉搏血氧饱和度、平均动脉压、中心静脉压和中心静脉血温；进行动脉血气分析（pH、氧分压、二氧化碳分压、碱剩余），测定血钾、血钙、血糖、凝血酶原时间、凝血酶时间、活化部分凝血活酶时间和纤维蛋白原。12例患儿均痊愈出院。术中保温、平稳的麻醉诱导和维持、围术期维持稳定的血液动力学、有效的肝、肾、心脏保护措施、及时调整血气和电解质、凝血功能的监测和管理和免疫抑制治疗等均是保证儿童肝移植手术成功的关键。From January 2006 to September 2006 anesthesia was done for twelve ASA Ⅲ or Ⅳ children undergoing liver transplantation in Charite Hospital. Oxygen and sevoflurane were inhaled by mask before the vein on the fight arm was cannulated. Anesthesia was induced intravenously with midazolam 0.1-0.15 mg/kg, propofol 2-3 mg/kg, fentanyl 2-5 μg/kg, and rocuronium 1-1.2 mg/kg and maintained with isoflurane inhalation and propofol infusion and intermittent i.v. boluses of fentanyl and rocuronium. The cardiovascular support included dopamine, nitroglycerine, norepinephrine and/or epinephrine during operation. The temperature was maintained with heating devices such as heating bed , heating blanket and fluid warming. The durations of portal circulation interruption and surgery were 60-140 min and 420-610 rain. HR, ECG, SpO2, MAP, CVP, central venous blood temperature were monitored. Blood gas analysis （pH, PaO2, PaCO2, BE）, blood K^＋, Ca^2＋ and glucose levels were determined. The prothrombin time, partial prothrombin time, activated partial prothrombin time and fibrinogen levels were also measured . All 12 patients were discharged from the hospital without any complications.

关 键 词：儿童 肝移植 麻醉 

分 类 号：R686[医药卫生—骨科学]