背驮式肝移植术中再灌注综合征的预防策略  

Strategies for Prevention of Post-reperfusion Syndrome in Orthotopic Liver Transplantation

作　　者：梁宁[1] 黄中华[1] 秦丹丹[1] 张庆敏[1] 张学刚[1] 

机构地区：[1]广西壮族自治区人民医院麻醉科,南宁市530021

出　　处：《广西医学》2009年第12期1759-1762,共4页Guangxi Medical Journal

基　　金：广西科学基金(桂科回0731010)

摘　　要：目的观察综合处理及适当应用血管活性药物等策略对改良背驮式肝移植术供肝再灌注损伤的保护作用,以预防术中再灌注综合征(PRS)的发生,提高肝移植术患者的安全性。方法21例终末期肝病患者均在气管内插管静吸复合麻醉下行改良背驮式肝移植术。均在颈内静脉放置漂浮导管,围术期给予扩容、纠酸、保温、补钙等综合处理及合理应用血管活性药物。记录麻醉前,无肝期前5min,无肝期即时,无肝期10min、30min,新肝期即时,新肝期10min、30min、60min,术毕时的MAP、HR、CVP、PAP及患者咽温、尿量、血气分析、电解质、血糖的变化。结果围术期血流动力学基本稳定;无肝早期(门静阻断5min内)和新肝早期(门静脉开放后5min内)的MAP、CVP、PAV较无肝前期、麻醉前轻度降低,HR轻度增快;新肝期MAP、HR恢复到无肝前期水平;生化、血气分析在正常范围,血钙偏低;围术期血糖有渐升高趋势,但未超过10mmol/L,未采取特殊处理;21例患者均未出现PRS。结论改良背驮式肝移植术中门静脉开放前给予扩容、纠酸、保温、补钙等综合处理以及适量应用血管活性药等策略可预防再PRS的发生。Objective To investigate the preventive effect of comprehensive treatment and the use of vasoactive agents on post-reperfnsion syndrome in patients undergoing orthotopic liver transplantation in order to avoiding post reperfnsion syndrome. Methods 21 patients who received orthotopic liver transplantation were given comprehensive treatment（including fluid supplementation,anti-acidosis,warming and calcium supplement）and low-dose dopamine（2 - 10 μg · kg-1· min-1 ）and other vasoactive agents during the operation. The changes of mean artery pressure （ MAP ）, heart rate （ HR ）, central venous pressure （ CVP）, pulmonary artery pressure （PAP）, body temperature, urinary output,blood gas analysis, blood sugar and electrolyte were recorded at different time-points during perioperative period. Results The hemodynamicsof all patients was stable during the operation. Compared with the pre-anhepatic phase, MAP,PAP and CVP mildly decreased while HR mildly increased during the early anhepatic phase（within 5 minutes after the portal vein occlusion）and the early reperfusion phase（within 5 minutes after the portal vein reperfusion）. MAP and FIR returned to the baseline of the pre-anhepatic phase during the reperfusion phase. Blood gas analysis and electrolyte were normal. Although calcium decreased and blood sugar increased mildly during preoperative period,there was no need to manage it. There was no post-repeffusion syndrome occurred in the eight patients. Conclusion Comprehensive treatment and the use of vasoactive agents before the portal vein reperfusion in patients undergoing orthotopic liver transplantation may have preventive effects on post-reperfusion syndrome.

关 键 词：背驮式肝移植术 血流动力学 再灌注综合征 预防 

分 类 号：R614.2[医药卫生—麻醉学]