56例背驮式原位肝移植麻醉的临床分析  

56 Cases Clinical Anaesthesia Analysis of Piggyback Orthotopic Liver Transplantation

作　　者：梁荣毕[1] 李俊明[1] 彭沛华[1] 衡新华[1] 

机构地区：[1]昆明医学院第一附属医院麻醉科,昆明650032

出　　处：《中国医药导刊》2008年第9期1349-1351,共3页Chinese Journal of Medicinal Guide

摘　　要：目的:观察背驮式原位肝移植(PBOLT)麻醉过程中血流动力学、酸碱电解质和凝血等的变化规律并总结分析。方法:56例肝病晚期行PBOLT的病人,采用气管内插管静吸复合全身麻醉,分别于切皮前、无肝前期、无肝期、新肝期采集血流动力学指标,酸碱电解质、血糖及凝血功能等检测结果,观察其变化规律。结果:无肝期平均动脉压(MAP)下降和心率(HR)增快,新肝期5min体循环阻力(SVR)和MAP下降,而HR进一步增快,并出现明显的代谢性酸中毒,无肝期及新肝期出现明显的低钙血症,新肝再灌注后血糖持续升高,与切皮前比较差异显著(P<0.05)。结论:PBOLT病人,在无肝期和新肝再灌注期仍会出现明显的血流动力学、酸碱电解质和血糖的变化,良好的麻醉管理是手术成功的重要环节。Objective： To observe the changes of haemodynamics,acid-base and electrolytes ,and hlood coagulation during operation of piggyback orthotopic liver transplantation （PBOLT）. Methods： 56 cases of late hepatosis to have PBOLT received endotracheal intubation and inlravenous-inhalation anesthesia, and collected their arterial blood to assay blood gas, acid-base and electrolytes ,blood glucose and blood coagulation,as well as monitored haemodynamics separately during pro-skin incision, pre-anhepatie phase, anhepatic phase and neeanhepatic phase. Resdts： Mean artery pressure （MAP） decreased and heart rate （HR.） increased during anhepatic phase, metabolic acidosis during anhepatic phase, obvious metabolie of neohepatic phase at 5th minute, obvious hypocaleemia during anhepatic phase and neohepatic phase. The blood sugar raised continuously after reperfusion in neohepatic phase. The differences were significant compare to those of pro-skin incision （P〈0.05）. Conclusions： The acid-base, electrolytes and blood sugar were obviously changed during anhepatie phase, neohepatic phase and after reoerfusion in PBOLT oatients. Controlling these changes oromotlv is a kev segment in auesthesia management.

关 键 词：原化肝移植 麻醉 

分 类 号：R614[医药卫生—麻醉学]