肝移植无肝期容量管理对术后肾功能的影响  

Subdivision and Capacity Management of Anhepatic Phase in Piggy-Back Liver Transplantation

作　　者：闫清[1] 刘晓峰[1] 王额尔敦[1] 郑永顺[1] 王延文[1] 沈为民[1] 强显成 逄伟斌 

机构地区：[1]解放军第401医院麻醉科

出　　处：《中华全科医学》2010年第7期833-835,共3页Chinese Journal of General Practice

摘　　要：目的探讨背驮式肝移植手术无肝期的进一步细分和容量管理对术后肾功能的影响。方法将无肝期划分为门静脉阻断期和下腔静脉阻断期,肝移植手术患者77例,记录无肝前期、门静脉阻断期、下腔静脉阻断期和新肝期的尿量,采用不同的输液管理方法 ,观察与术后肾衰竭发生率的关系。结果以尿量为指标指导容量管理,与无肝前期比较,下腔静脉阻断期尿量显著降低,新肝期尿量显著增加;下腔静脉阻断期和新肝期少尿发生率显著增多、少尿纠正率显著降低;9例达到ARF诊断标准(11.7%),术后ARF患者与肾功能正常者的术中无肝期时间、低血压时间、术后低血压时间无显著延长,但出血量显著增多、术中少尿时间显著延长。结论将无肝期再细分,有区别地补充容量维持正常尿量是可行的,术中血液动力学比较稳定,术后肾脏功能恢复比较满意。Objective To investigate the impact of renal function by making further subdivision of anhepatic phase in Piggy-back liver transplantation and investigate capacity management in every phase.Methods The anhepatic period was partitioned into portal vein cross-clamping period and inferior vena cava cross-clamping period.77 patients undergoing Piggy-back liver transplantation surgery were selected.To record urinary volume in every phase and observe the relation of urinary volume and renal failure incidence.Results Taking urinary volu By contrast with anhepatic prophase,urinary volume decreased in inferior vena cava cross-clamping period and that in neo-liver period was increased significantly;oliguria incidence rate was increased and oliguria rectification rate was decreased significantly in inferior vena cava cross-clamping period and neo-liver period.9 cases（11.7%）fited diagnostic criteria of ARF.Between ARF patients and the others with normal renal function,the time of anhepatic phase,hypotension during operation and hypotension after operation were no prolongation notably.But bleeding volume increased and oliguria time prolonged notably during operation.Conclusion It is feasible to make anhepatic phase subdivision and maintain urinary volume by adding capacity discretely.Haemodynamics during operation is stable and recovery of renal function after operation is satisfactory relatively.

关 键 词：肝移植 背驮式 无肝期 尿量 术后早期急性肾衰 

分 类 号：R657.3[医药卫生—外科学]