原位肝移植术的围术期麻醉管理(附60例报告)  

ANESTHESIA MANAGEMENT FOR ORTHOTOPIC LIVER TRANSPLANTATION(60 CASES REPORT)

作　　者：秦科[1] 孙煦勇[1] 陈伯成[1] 钟军[1] 赖彦华[1] 董建辉[1] 李壮江[1] 周洁惠[1] 

机构地区：[1]解放军第303医院器官移植中心,广州军区肝,肾移植中心,南宁530021

出　　处：《广西医科大学学报》2011年第5期695-699,共5页Journal of Guangxi Medical University

基　　金：广西壮族自治区科技攻关项目(No.0719006-2-7);广西自然科技基金(No.桂科自0728252)

摘　　要：目的:探讨原位肝移植手术的麻醉方法和围手术麻醉期的管理与调控。方法:60例终末期肝病患者在全麻下行原位肝移植术。分别于术前(T0),无肝前10min(T1),无肝期30min(T2),新肝期30min后(T3),新肝期60min后(T4)和术毕(T5),通过桡动脉置管和Swan-Ganz导管获得心脏指数(CI)、平均肺动脉压(MPAP)、肺动脉楔压(PAWP)、中心静脉压(CVP)、全身血管阻力(SVR)、肺血管阻力(PVR)、氧供(DO2)、氧耗(VO2)、氧摄取率(ERO2)、动脉血乳酸(ABL)、混合静脉血氧饱和度(SvO2)和血气与电解质分析;同时亦通过血栓弹力图仪(TEG)监测围术期凝血功能及指导输血与凝血因子输注。术中根据血流动力学变化情况使用多巴胺、去甲肾上腺素和肾上腺素,根据检查结果及时适当补充电解质和调整酸碱平衡。结果:与T0比较,T2-5HR增加,在T2时MAP、CI、CVP、MPAP、PCWP急剧下降,SVR增加(P<0.05或P<0.01),T3时CI上升(P<0.05),SVR下降(P<0.05),T5时各项指标逐渐恢复至T0水平。T2时DO2、VO2、DO2I、VO2I下降(P<0.05),ERO2增加(P<0.05),T3时DO2、VO2、DO2I、VO2I升高(P<0.05);ABL在T2-5增加(P<0.05)。结论:原位肝移植术围术期具有复杂的血流动力学改变、氧代谢变化、内环境紊乱及凝血功能不全,术中应密切监测各项指标以指导术中麻醉管理,同时注意加强心、肺、肾等系统功能的保护。Objective：To evaluate the perioperative anesthesia methods and management during the orthotopic liver transplantation.Methods：Sixty patients with end-stage liver disease were received orthotopic liver transplantation in general anesthesia.Cardiac index（CI）,mean pulmonary artery pressure（MPAP）,pulmonary artery wedge pressure（PAWP）,central venous pressure（CVP）,systemic vascular resistance（SVR）,pulmonary vascular resistance（PVR）,oxygen supply（DO2）,oxygen consumption（VO2）,oxygen uptake rate（ERO2）,arterial blood lactate（ABL）,mixed venous oxygen saturation（SvO2） and arterial blood gas and electrolyte analysis were monitored through the radial arterial catheter and Swan-Ganz catheter at different time： before operation（T0）,10 min befor anhepatic（T1）,30 min after anhepatic period（T2）,30 min after neohepatic（T3）,60 min after neohepatic（T4） and the end of operation（T5）.At the same time,thromboelastography（TEG） monitored the perioperative blood coagulation function and guided the clotting factor and blood infusion.Results：Compared with T0,HR increased in T2-5,MAP,CI,CVP,MPAP,PCWP sharply declined and SVR increased at T2（P0.05 or P0.01）,CI increased and SVR decreased at T3（P0.05）,the indicators gradually restored to the T0 level at T5,DO2,VO2,DO2I,VO2I decreased and ERO2 increased（P0.05） at T2,DO2,VO2,DO2I,VO2I increased at T3（P0.05）;ABL increased at T2-5（P0.05）.Conclusion：It is critical for a successful operation to maintain stabilization of hemodynamics,relieve the ischemic reperfusion injury,have correct transfusion treatment,as well as adjust the metabolic disorder and blood clotting disfunction.

关 键 词：肝移植 麻醉 

分 类 号：R614[医药卫生—麻醉学]