原位肝移植术中血流动力学的变化和麻醉处理  

Changes of hemodynamic and internal environment of the patients with orthotopic liver transplantation and anesthesia management

作　　者：张慧娟[1] 杨建平[1] 矫勇轶[1] 朱晓刚[1] 须挺[1] 江漩[1] 

机构地区：[1]苏州大学附属第一医院麻醉科,215006

出　　处：《中华器官移植杂志》2002年第4期210-212,共3页Chinese Journal of Organ Transplantation

摘　　要：目的 探讨原位肝移植患者无肝前期、无肝期和新肝期血流动力学、内环境变化和麻醉处理。方法6例终末期肝病患者,5例接受肝移植术,1例接受肝、肾联合移植术。观察术中诱导期、无肝前期、无肝期、新肝期不同时点的平均动脉压（MAP）、中心静脉压（CVP）、心率（HR）、心电图（ECG）、血氧饱和度（SpO2）、二氧化碳分压（PaCO2）、血糖（Glu）、体温和尿量。结果 无肝期开始及进入新肝期MAP明显下降;HR变化增快,pH和剩余碱（BE）等代谢性指标变化较大,尤其是在新肝期BE平均下降4.4,呈代谢性酸中毒表现 ; 2例患者在无肝期和新肝期开始的10 min内,血 K+升高;无肝期后血糖明显升高;所有患者在手术期间血 Caz”均偏低。结论 肝移植手术期间,尤以无肝期和新肝期早期,血流动力学、电解质和酸碱平衡、血糖等变化突出。应采取及时补充血容量,应用血管活性药物,纠酸、补钙,降低血糖等措施。To study the hemodynamic and internal environment changes of the patients with orthotopic liver transplantation and anesthesia management during surgery. Methods Among 6 cases of end-stage liver disease, 5 underwent liver transplantation and one received combined liver-kidney transplantation. MAP, HR, CVP, plasma K+ , Ca2+ , glucose, and blood analysis for pH, PaCO2 and BE were observed during induction, pre-anheptic, anheptic and reperfusion phases. Results In all 6 cases, MAP were significantly decreased and HR were increased during anheptic and reperfusion phases. pH value and BE had obvious changes and the patients were in the state of metabolic acidosis during reperfusion phase. There were 2 patients with increased plasma K+ at the beginning of anheptic and reperfusion phases. The patients plasma glucose was significantly increased after anheptic phase. Plasma calcium was in lower level during the surgery. Conclusions There were profound changes in hemodynamics, plasma electrolytes, acid-base and plasma glucose during liver transplantation, especially at the early phases following liver removal and re-vascularization. The main treatments included volume replacement, anti-acidosis, calcium supplement and controlling hyperglycemia.

关 键 词：手术中 原位肝移植 血流动力学 麻醉处理 

分 类 号：R657.3[医药卫生—外科学] R614[医药卫生—临床医学]