不同灌注方法对原位肝移植麻醉的临床效果分析  

Clinical Analysis about Different Methods of Retrograde Perfusion for Anesthesia on the Orthotopic Liver Transplantation

作　　者：董刚[1] 任波[1] 郭晓东[1] 徐晨[1] 刘芳婷[1] 李晶[1] 刘霞[1] 毕振华[1] 刘振文[1] 

机构地区：[1]解放军第302医院,北京100039

出　　处：《现代生物医学进展》2014年第7期1297-1299,1364,共4页Progress in Modern Biomedicine

基　　金：院长创新基金项目(YNKT2010011)

摘　　要：目的:观察下腔静脉逆灌注法与常规门静脉正向灌注法应用于经典非转流原位肝移植手术的临床效果,并比较两种灌注法对新肝期再灌注后综合征的影响。方法:回顾性分析我院行经典非转流肝移植手术的患者60例,按照灌注方法的不同分为两组:A组(30例)采用下腔静脉逆灌注法;B组(30例)采用门静脉正向灌注法。比较两组患者围手术期的血流动力学指标、体温、内环境的改变等情况。结果:①分别在新肝开放即刻、新肝期5分钟及15分钟观察两组患者的平均动脉压、肺动脉压楔压、心率变化程度及心脏指数,A组均小于B组,差异有统计学意义(P<0.05);②分别于新肝期5分钟及15分钟观察两组患者的中心静脉压,A组低于B组(P<0.01);③观察开放时两组患者的最低温度,A组高于B组(P<0.01);④观察血管活性药物用量,A组少于B组,差异有统计学意义(P<0.05)。结论:经典非转流肝移植术中,采取逆灌注方法可减少术后再灌注综合征的发生。两种灌注方式均需要加强对血流动力学、体温、酸碱平衡的监测与调整,做到针对性的麻醉管理。Objective： To observe the applications of different retrograde perfusion methods on the orthotopic liver transplantation without venous bypass, and to compare the clinical effects on the post reperfusion syndrome. Methods： Sixty patients with orthotopic liver transplantation who were treated in our hospital were selected and randomly divided into two groups according to different perfusion methods. Group A with 30 cases, were unclamped before portal anastomosis, while group B with another 30 cases were performed the normal perfusions via portal veins. The hemodynamic parameters, body temperature, changes of internal environment and fluid therapy of patients were compared between the two groups. Results： ① The changes in systolic blood pressure, diastolic blood pressure and heart rate in group A were less than those of group B at the beginning ofneohepatic phase, the fifth minutes and the fifteenth munites respectively, and there were statistically significant differences between two groups（P〈0.05）;②The central venous pressure was significantly lower than that of group B at the fifth and tenth minutes ofneohepatic phase, and there was statistically significant difference between two groups （P〈0.05）; ③At the early neohepatic stage, the body temperature in group A were significantly lower than that of the group B. ④The requirement of vasoactive drugs in the group A was significantly smaller than that of the group B, and there was statistically significant difference between two groups （P〈0.05）. Conclusion： Compared with traditional perfusion, the retrograde perfusion in the orthotopic liver transplantation is more useful to relieve the post reperfusion syndrome. It is suggested that the hemodynamics, body temperature, and internal environment should be emphasized to monitor and regulate the OLT.

关 键 词：经典非转流肝移植 麻醉 灌注方法 再灌注综合征 

分 类 号：R575[医药卫生—消化系统]