肝肾联合移植术的麻醉和围手术期处理  

ANESTHESIA AND PERIOPERATIVE MANAGEMENT IN COMBINED LIVER-KIDNEY TRANSPLANTATION

作　　者：秦科[1] 孙煦勇[1] 陈伯承[2] 钟军[2] 赖彦华[2] 董建辉[2] 肖曙峰[2] 

机构地区：[1]广西医科大学第一附属医院心血管病研究所手术麻醉室,南宁530021 [2]解放军第303医院器官移植中心

出　　处：《广西医科大学学报》2010年第1期76-78,共3页Journal of Guangxi Medical University

基　　金：广西壮族自治区科技攻关项目(0719006-2-7);广西自然科学基金资助项目(桂科自0728252)

摘　　要：目的:总结5例同种异体肝肾联合移植术的麻醉方法和围手术期的治疗措施。方法:对5例肝肾联合移植术患者,其中多囊肝、多囊肾3例(其中1例合并肢端肥大症),乙型肝炎肝硬化合并严重肝肾综合征2例,肝功能Child-Pugh分级B级1例,C级4例,MELD评分16～25分,ASAⅢ～Ⅳ级,实施以静脉性麻醉药为主复合吸入全麻方法;围手术期采用维持心血管循环功能的稳定;术后早期目标容量治疗;大剂量乌司他丁等减少缺血—再灌注损伤治疗;甲强龙+抗CD25单克隆抗体舒莱诱导治疗,FK506(他克莫司)+骁悉(MMF)+泼尼松的三联方案免疫抑制方案等综合治疗措施。结果:5例患者手术全部获得成功,围手术期存活率100%,患者痊愈出院。5例患者移植肾开放血流后均在5min内出现泌尿并维持在100～500mL/h,其中1例于术后出现急性肾小管坏死出现少尿,经规则血透后肾功能逐渐恢复正常。结论:肝肾联合移植术采用静脉性麻醉药为主复合吸入全麻方法,围术期采用维持心血管循环功能的稳定,术后早期目标容量治疗,减少缺血—再灌注损伤治疗,三联方案免疫抑制方案等综合治疗措施可保障围术期的生命安全,有效地恢复移植肝肾功能。Objective. To summarize the method of anesthesia and perioperative treatment measures in the five cases of combined liver-kidney allograft transplantation. Methods：From Jan. 2005 to Dec. 2009, 5 patients including polycystic liver and kidney disease （ n = 3, 1 case combined acromegaly）, hepatitis B cirrhosis with severe hepatorenal syndrome（ n = 2）, Child-Pugh classification B（ n = 1）, grade C（ n = 4）, MELD score 16-32, ASA [II - IV level, were subjected to combined liver-kidney transplantation under intravenous general anesthesia combined inhalation in our department. In perioperative time,we took a comprehensive therapeutic measures, including hemodynamic stability, early postoperative target volume treatment; reduction of ischemia-reperfusion injury treatment by high-dose ulinastatin, immuned induction therapy giving a strong dragon ＋ anti-CD25 monoclonal antibody （Simulect）, triple immunosuppression programs of FKS06 （tacrolimus） ＋ mycophenolate mofetil （MMF） ＋ prednisone. Results： All 5 patients performed successful operation and discharged, with perioperative survival rate of 100%. All patients screted urine within 5min after opening up blood in transplanted-renal and maintained at 100-500 mL/h. One case occurred postoperative oliguria, owing to acute tubular necrosis, but renal function gradually returned to normal after the rules hemodialysis. Conclusion：Proper anesthesia and surgical technique, and postoperative careful comprehensive treatment measures are essential and effective to restoration of transplanted liver and kidney function undergoing combined liver-kidney allograft transplantation.

关 键 词：肝肾联合移植 麻醉 血流动力学 缺血-再灌注 免疫抑制 

分 类 号：R617[医药卫生—外科学]