活体部分肝移植受体围术期容量和循环变化及调控  

Perioperative volume and circulation management of living donor liver transplantation

作　　者：魏涧琦[1] 罗刚健[1] 关健强[1] 黑子清[1] 

机构地区：[1]中山大学第三附属医院麻醉科,广州510630

出　　处：《中华普通外科学文献（电子版）》2010年第1期23-26,共4页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的总结和分析我院18例活体肝移植受体围术期体液和循环变化的麻醉管理的经验和体会。方法回顾性分析2007年5月至2008年10月我院18例活体肝移植的临床资料。其中男17例，女1例；肝癌9例，慢性重型肝炎肝硬化9例。所有受体均接受右半肝移植（Ⅴ—Ⅷ段），采用背驮式术式。结果18例肝移植手术均成功。手术时间为（10．5±1．6）h，无肝期较长（100±15）min。术中出血量（3240±268）ml。活体肝移植新肝期血流动力学参数恢复较快；无肝期末和新肝期凝血功能明显改善。手术开始至新肝期出现低钾血症5例，与术前比较差异有统计学意义（P〈0．05）。肝脏恢复灌注后，3例出现高钾血症，手术开始至新肝期，6例出现低钙血症，明显低于术前水平（P〈0．05）。术中易出现代谢性酸中毒，无肝期末及新肝期1。5min更为明显，与术前比较差异有统计学意义（P〈0．05）。结论活体肝移植无肝期时间较长，水、电解质和血流动力学改变显著，新肝期要注意纠正长时间缺血后的再灌注损伤，要努力纠正血流动力学、内环境和凝血功能的紊乱。Objective To summarize and analysis the perioperative anesthesia management experience of 18 living donor liver transplantation cases. Methods A retrospective analysis about clinical data of 18 living donor liver transplantation eases from May 2007 to October 2008 in our hospital were made. Among these, 17 were male and 1 was female, including 9 cases of liver cancer, chronic severe hepatitis 9 cases of liver cirrhosis. All receptors were accepted right liver transplantation using piggyback operation. Results All liver transplant surgery of 18 cases were successful. The operative time were （10.5± 1.6） hours, anhepatic phases was （100 ± 15） minutes. Intraoperation blood loss were （3240 ±268） ml. Neohepatic phase of liver hemodynamic parameters recovered quickly. In neohepatie phase and the end of anhepatic phases coagulation function improved significantly. Five cases appeared hypokalemia and 3 appeared hyperkalemia, 6 of them appeared hypocaleemia. Metabolic acidosis often oecured in the operation, especially in the end of anhepatie phases and 1-5 minutes of neohepatic phase（P〈0.05）. Conclusions Anhepatic phases of living donor liver transplantation last a longer time. More attention should be paid to correct the hemodynamics and water-electrolyte imbalance due to ischemia reperfusion injury in neohepatic phase. The improvement of coagulation function, homestasis will be benefieal to cases.

关 键 词：肝移植 围手术期 血流动力学 水电解质失衡 凝血功能 活体 

分 类 号：R657.3[医药卫生—外科学]