肝硬化病人肝移植术中右心室容量的变化  

Changes of right ventricular volume during liver transplantation in patients with liver cirrhoses

作　　者：赵秋华[1] 岳云[2] 

机构地区：[1]北京市石景山医院麻醉科,100043 [2]首都医科大学附属北京朝阳医院麻醉科

出　　处：《国际麻醉学与复苏杂志》2008年第1期16-19,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的采用右心室舒张末容量指数监测，观察评估肝硬化病人肝移植术中右心室容量的变化。方法拟行改良背驮肝移植手术病人26例，ASA Ⅲ或IV级，肝功能Child分级B级22例、C级4例，心功能I或Ⅱ级。分别在切皮前（T0）、无肝期前10min（T1）、无肝期30min（T2）、新肝期15min（T3）、新肝期30min（T4）和新肝期90min（B）记录右心室舒张末容量指数（RVEDVI）、心指数（CI）、右室射血分数（RVEF）和每搏量指数（SVI）等参数。结果与Tn比较，无肝期RVEDVl、RVEF、CI和SVI均下降；进入新肝期后RVEDVI、RVEF、CI和SVI在T3时下降，T4时回到T0水平。与T2比较，1r3的RVED．VI、RVEF、CI和SVI变化不明显，T4的RVEDVI、RVEF、CI和SVI增加。与T3比较，T4和T5的RVEDVI、RVEF、SVI和CI明显增加。结论RVEDVI能较好评估肝硬化肝移植病人的右心室的容量变化。Objective To investigate the changes of right ventricular volume during liver transplantation in patients with liver cirrhoses. Methods Twenty - six ASA II or III patients with liver cirrhoses undergoing liver transplantation were studied. Their cardiac functions were graded to be class I or II according to New York Heart Association （NYHA） classification. After anesthetic induc- tion, volumetric pulmonary artery catheter was placed in pulmonary artery via right internal jugular vein. Right ventricular end - diastolic volume index （RVEDVI）, right ventricular eject fraction （RVEF）＇, cardiac output index （CI） and stroke volume index （SVI） were recorded before operation （To ）, 15 min before anhepatic phase （T1）, 30 min after onset of anhepatic phase （T2）, 15 min after graft reperfusion（T3 ）, 30 min after graft reperfusion（T4 ） and 90 min after graft reperfusion （T5 ）. Results Comparing with To, RVEDVI, RVEF, RVEF, CI and SVI decreased at T3 and T4. Comparing with T2, RVEDVI, RVEF, CI and SVI remained stable at T3, increased at T4. Comparing with T3, RVEDVI, RVEF, CI and SVI increased both at T4 and Ts. Conclusion In this clinical study, RVEDVI can evaluate right ventricular volume in patients with cirrhoses undergoing liver transplantation.

关 键 词：肝移植 肝硬化 心脏容量 导管置入术 

分 类 号：R614[医药卫生—麻醉学] R657.3[医药卫生—外科学]