非静脉-静脉转流肝移植术中酸碱及电解质的变化  

Blood gas and electrolytes alterations of recipients during allograft orthotopic liver transplantation without venous-venous bypass

作　　者：朱伟[1] 朱敏敏[2] 金文杰[1] 谈珊柏[1] 

机构地区：[1]南京医科大学第一附属医院麻醉科,江苏南京210029 [2]南京军区南京总医院博士后科研工作站,江苏南京210002

出　　处：《南京医科大学学报（自然科学版）》2008年第9期1162-1165,共4页Journal of Nanjing Medical University(Natural Sciences)

摘　　要：目的:探讨非静脉-静脉转流肝移植手术患者术中酸碱及电解质变化的临床意义。方法:46例终末期肝病患者在静吸复合身麻醉下行背驮式肝移植术,分别在无肝前期(切皮后20min)、无肝期10、20、30、60min及新肝期10、20、30、60min时间点,采集外周动脉血检测pH值、二氧化碳分压(PCO2)、碳酸氢根(HCO3-)和血钠(Na+)、血钾(K+)、血钙(Ca2+)、血糖(BG)。结果:新肝期的10、20和30min时间点pH值显著降低(分别为P<0.001,P<0.001和P<0.05);PCO2在无肝期的60min(P<0.05)及新肝期各时间点均增高(分别为P<0.001,P<0.001,P<0.001和P<0.05);HCO3-在无肝期的20min(P<0.001)、30min(P<0.01)、60min(P<0.01)及新肝期的10min(P<0.001)、20min(P<0.01)、30min(P<0.01)均增高。新肝期10minK+和Na+浓度均显著降低(分别为P<0.001,P<0.01)。Ca2+浓度在围手术期无统计学差异。BG在无肝期10min(P<0.05)、20min(P<0.05)时间点和新肝期的10min(P<0.001)、20min(P<0.001)、30min(P<0.01)时间点均增高。结论:新肝期早期阶段易出现复合型酸碱失衡。Objective：To investigate the clinical significance of changes of acid-base and electrolytes in different phases during the procedure of orthotopic liver transplantation （OLT）. Methods：Forty-six recipients who underwent liver transplantation with the piggyback technique under general anaesthesia were analyzed retrospectively. Blood samples collected during the phase of procedure for values included arterial pH, partial carbon dioxide pressure （PaCO2）, standard bicarbonate values （HCO3^-） and serum potassium （K^＋）, ionized calcium（Ca^2＋） ,sodium（Na^＋） ,blood glucose levels（BG）. The measurements were performed at nine time points：20 min after the skin incision （baseline）, 10,20,30,60 minutes during the anhepatic phase, and 10,20,30,60 minutes after reperfusion. Results： The pH in the phase of revascularization of liver was significantly lower at 10 min,20 min and 30 min（P 〈 0.001 ,P 〈 0.001 and P 〈 0.05 ,respectively）; PCO2 was higher in anhepatic phase at 60 min （P 〈 0.05） and in the phase of revascularization of liver at all time points（P 〈 0.001 ,P 〈 0.001 ,P 〈 0.001 and P 〈 0.05 ,respectively）; HCO3^- was higher during anhepatic phase at 20 min,30 min and 60 min （P 〈 0.001 ,P 〈 0.01 and P 〈 0.01 ,respectively） and 10 min,20 min and 30 min during the phase of revascularization （P 〈 0.001 ,P 〈 0.01 and P 〈 0.01 ,respectively）. K^＋ and Na^＋decreased significantly in the phase of revascularization at 10 min time point （P 〈 0.001 ,P 〈 0.01 ,respectively）. No difference of Ca^2＋ was observed among the nine time points during the phases of procedure. Mean glucose levels increased in anhepatic phase at 10 min, 20 min（both P 〈 0.05） and 10 min, 20 min, 30 min during the phase of revascularization （P 〈 0.001 ,P 〈 O.01 and P 〈 0.01 ,respectively）. Conclusion：Mixed acid-base disturbances were observed in the early stage of revascularization phase during the procedure of OLT.

关 键 词：肝移植 酸碱 电解质 

分 类 号：R657.3[医药卫生—外科学]