经典非转流肝移植术中下腔静脉血酸碱及电解质变化  

Changes of Blood Gas Samples in Inferior Vena Cava during Standard Orthotopic Liver Transplantation

作　　者：王亮[1] 薛玉良[2] 杜洪印[1] 

机构地区：[1]天津市第一中心医院麻醉科,300192 [2]泰达国际心血管病医院麻醉科

出　　处：《天津医药》2008年第7期496-498,共3页Tianjin Medical Journal

摘　　要：目的:探讨非转流经典原位肝移植术中患者下腔静脉血血气和电解质变化及其原因。方法:26例行经典非转流原位肝移植患者,采用气管内插管静吸复合麻醉。经右颈内静脉和右股静脉穿刺置入中心静脉导管。于开腹前(T0)、无肝期前5min(T1)、新肝开放前5min(T2)、新肝期15min(T3)、新肝期30min(T4),分别从右颈内静脉、右股静脉导管抽取上、下腔静脉血,进行血气、电解质分析。结果:与上腔静脉比较,下腔静脉血氧分压[p(O2)]在T2时降低(P<0.01),pH、剩余碱(BE)、二氧化碳分压[p(CO2)]、血钾、血糖和乳酸水平与上腔静脉血差异无统计学意义(均P>0.05)。与T0比较,下腔静脉pH、BE在T2时下降,新肝期15min分别降达最低值[7.283±0.060、(-5.4±3.1)mmol/L],而p(CO2)于T2、T3升高。结论:无肝期阻断远端下腔静脉血除出现明显的低氧血症外,未见严重的高钾血症和酸中毒表现,提示再灌注综合征与下腔静脉血钾水平和酸碱状态无关。Objective： To investigate the effects of blood gas and electrolytes in inferior vena cava（IVC）during standard orthotopic liver transplantation （SOLT） without veno-venous bypass. Methods： Twenty-six patients with end-stage liver disease were performed SOLT under general anesthesia. The catheters were inserted through the right jugular vein and the right femoral vein for IVC and superior vena cave （SVC） blood collection. The blood gas and electrolytes from IVC and SVC were measured before operation （To）, 5 min before cross-clamping of the portal vein （T1）, 5 rain before unclamped of portal vein（T2）, 15 min（T3）and 30 rain（T4） in neohepatic phase. Results： Oxygen in mixed venous bloodp（O2） of IVC declined significantly compared with that of SVC at time T2（P 〈 0.01 ）.There were no significant differences in pH, BE ,p （CO2）, blood glucose,lactic acid between IVC and SVC at the time T2. The values of pH and BE decreased after cross-clamping the portal vein at T2 in IVC ,and reached their minimum value [7.283 ± 0.060, （-5.4 ± 3.1 ）mmol/L] in T3. At the same time ,p（CO2） of IVC was increased at T2 and T3. Conclusion： In anhepaic phase,there was no serious hyperkalemia and acidosis of IVC under the clamp. It is suggested that post reperfusion syndrome （PRS） does not seem to be related to potassium level and acid-base equilibrium of IVC.

关 键 词：肝移植 腔静脉 下 血气分析 电解质 再灌注损伤 高钾血症 

分 类 号：R657.3[医药卫生—外科学] R722.12[医药卫生—临床医学]