背驮式肝移植术中肺动脉压及血流动力学的变化  

Changes of pulmonary arterial pressure and hemodynamics during piggyback orthotopic liver transplantation

作　　者：杨吉武[1] 罗显荣[1] 朱新运[1] 李保安[1] 邹柳华[1] 

机构地区：[1]解放军第458医院麻醉科,广东广州510600

出　　处：《现代医学》2010年第4期342-345,共4页Modern Medical Journal

摘　　要：目的:探讨背驮式肝移植术中肺动脉压力及血流动力学的变化。方法:35例改良背驮式肝移植病人采用静吸复合全麻,连接迈瑞PM-9000多功能生理监测仪,麻醉后经右颈内静脉置入Swan-Ganz漂浮导管,记录麻醉后30min、无肝期前10min、无肝期5min、无肝期10min、无肝期30min、新肝期5min、新肝期10min、新肝期30min和新肝期60min平均动脉压(MAP)、中心静脉压(CVP)、心排血量(CO)、心脏指数(CI)、平均肺动脉压(MPAP)、肺动脉楔压(PCWP)、肺循环阻力指数(PVRI)、体循环阻力指数(SVRI)的变化。结果:与麻醉后30min比较,MAP、CVP、CO、CI、MPAP、PCWP在整个无肝期下降明显(P<0.05),PVRI和SVRI在无肝期上升(P<0.05);MAP在新肝期5min下降明显(P<0.01),MPAP、PCWP和CVP在新肝期10min明显升高(P<0.01),CO和CI在新肝期10min有一定增加(P<0.05),PVRI在新肝期5min上升明显(P<0.01),SVRI在新肝期5min降低(P<0.05)。结论:背驮式肝移植术虽然缩短了无肝期时间,但术中肺动脉压力及血流动力学的变化仍较明显,加强术中监测并及时给予处理十分重要。Objective：To study the changes of pulmonary arterial pressure and hemodynamics during piggyback orthotopic liver transplantation.Methods：35 patients who underwent piggyback orthotopic liver transplantations were anaesthetized with venous and inhalation combined systemic anesthesia,monitored inhalation by inhalation Mairui PM-9000 multifunctional physiological monitor.Under anesthesia,the Swan-Ganz flotation catheters were intubated by the right internal jugular vein.The mean artery pressure（MAP）,central venous pressure（CVP）,cardiac output（CO）,cardiac index（CI）,mean pulmonary artery pressure（MPAP）,pulmonary wedge pressure（PCWP）,the pulmonary circulation resistance index（PVRI） and systemic circulation resistance index（SVRI） were measured 30 minutes after anesthesia,10 minutes before no-liver period,5,10 and 30 minutes in no-liver period,5,10,30 and 60 minutes in new liver period.Results：Compared with 30 minutes after anesthesia,the MAP,CVP,CO,CI,MPAP and PCWP decreased obviously in the whole no-liver period（P 0.05）,the PVRI and SVRI increased（P 0.05） ;the MAP decreased obviously 5 minutes in the new liver period（P 0.01） ;the MPAP,PCWP and CVP increased obviously 10 minutes in the new liver period（P 0.01）,the CO and CI increased moderately 10 minutes in the new liver period（P 0.05） ;the SVRI decreased（P 0.05）,but in the contrast,the PVRI increased（P 0.01） 5 minutes in the new liver period.Conclusion：Although the piggyback orthotopic liver transplantation could shortened the no-liver period,the changes of the pulmonary arterial pressure and hemodynamics are significant,to strengthen the operative monitor and treatment are important.

关 键 词：背驮式肝移植 肺动脉压 血流动力学 

分 类 号：R657.3[医药卫生—外科学]