去甲肾上腺素对肝移植术中患者血流动力学的影响  

Hemodynamic effect of norepinephrine in patients undergoing orthotopic liver transplantation

作　　者：覃兆军[1,2] 雷志礼[1] 韩曙君[1] 冯国辉[1] 董兰[1] 刘多辉[1] 

机构地区：[1]武警总医院麻醉科,北京市100039 [2]徐州医学院

出　　处：《临床麻醉学杂志》2009年第1期7-9,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察单用去甲肾上腺素对肝移植术中患者血流动力学的影响。方法择期行原位肝移植术的晚期肝硬化患者40例,随机均分为去甲肾上腺素组(N组)和多巴胺组(D组)。分别于切皮前(T0)、切皮后1h(T1)、无肝期30min(T2)、新肝期1h(T3)及新肝期4h(T4)监测血流动力学指标。结果与T0时相比,两组HR在T1～T4时均增快(P<0.05);N组MAP在T2时明显高于D组(P<0.05),而D组HR在T2时又明显高于N组(P<0.05);与T0时相比,两组CVP、平均肺动脉压(MPAP)、心输出量(CO)、心指数(CI)T2时均下降(P<0.05);与T2时相比,两组以上指标在T3时均上升(P<0.05),但组间差异无统计学意义;与T0时相比,两组体循环血管阻力(SVR)及其指数(SVRI)、肺循环血管阻力(PVR)及其指数(PVRI)在T2时均上升(P<0.05);与T2时相比,两组以上指标在T3时均下降(P<0.05),但组间差异无统计学意义。结论在晚期肝硬化患者行肝移植手术中,单用去甲肾上腺素和多巴胺均可有效维持血流动力学稳定,且去甲肾上腺素对HR影响小,升高BP效果更明显。Objective To observe the effects of norepinephrine（NE） alone on hemodynamics in patients undergoing orthotopic liver transplantation（OLT）. Methods Forty adult patients undergoing orthotopic liver transplantation were randomly divided into two groups with 20 cases each. NE（group N） or dopamine（DA,group D） were continuously infused to maintain mean arterial blood pressure （MAP） 60-80 mmHg during anhepatic phase or 60-100 mmHg during the other phases. Hemodynamic variables such as hart rate （HR）, MAP, central venous pressure （CVP）, mean pulmonary arterial pressure （ MPAP）, cardiac output （CO）, cardiac index （ CI）, systemic vascular resistance（SVR）,systemic vascular resistance index（SVRI）, pulmonary vascular resistance（PVR）, pulmonary vascular resistance index（PVRI） were measured before incision （To baseline）, at 1 h after incision （T1）, 30 min after clamping portal vein （T2）, 1 h （T3） and 4 h （T4） after unclamping of portal vein. Results HR was significantly increased during operation in both groups （P〈0. 05）. MAP at T2 was significantly higher in group N than that in group D （P〈0. 05）, but HR at T2 was significantly higher in group D than that in group N （P〈0. 05）. CVP, MPAP, CO, and CI were significantly decreased at T2 ,but were significantly increased at T3 in both groups （P〈0.05）. On the contrary, SVR, SVRI, PVR and PVRI were significantly increased at T2 ,were significantly decreased at T3 in both groups （P〈0. 05）. Conclusion Either NE or DA＇ infusion can maintain hemodynamics stabile in the patients undergoing OLT, but NE is better than DA in rising blood pressure with less influence on HR.

关 键 词：肝移植 去甲肾上腺素 多巴胺 血流动力学 

分 类 号：R614[医药卫生—麻醉学] R657.3[医药卫生—外科学]