背驮式肝移植术中脑电双频指数指导下不同时期麻醉指标变化的临床分析  

Application of bispectral index to guide the depth of anesthesia in piggyback liver transplantation

作　　者：刘峰[1,2] 李雷[2] 蒋湘云[2] 郭颖[2] 王恒林[2] 

机构地区：[1]北京美莱医疗美容医院麻醉科,北京100020 [2]解放军第309医院麻醉科,北京100091

出　　处：《解放军医学院学报》2017年第5期452-455,共4页Academic Journal of Chinese PLA Medical School

摘　　要：目的评价脑电双频指数(bispectral index,BIS)指导下背驮式同种异体原位肝移植术中不同手术时期患者循环状态、肝肾功能、麻醉药物用量的变化趋势和麻醉效果。方法回顾性分析解放军第309医院2014年1月-2016年12月48例行背驮式同种异体原位肝移植手术患者术中的麻醉资料,所有患者均采用静-吸复合麻醉,维持BIS值在40~50,分析无肝前期、无肝期、新肝期患者的循环状态、肝肾功能、麻醉用药和尿量等特点。结果所有患者均顺利完成手术,总手术时间为(8.6±1.2)h,其中无肝前期为(3.6±0.7)h,无肝期(1.5±0.2)h,新肝期(3.8±0.4)h。从无肝前期到新肝期过程中,患者的心排血量和乳酸蓄积逐渐增加,肌酐清除率逐渐下降,尿量先减少后逐渐增加(P均<0.05)。术中1%丙泊酚总用量为(169.9±36.5)ml,其中无肝前期1%丙泊酚输注速度为(4.5±0.9)mg/(kg·h),无肝期较之明显减少,为(2.1±0.7)mg/(kg·h),新肝期丙泊酚的用量开始增加,但仍未达到无肝前期时水平,为(2.6±0.6)mg/(kg·h)(P均<0.05)。结论背驮式肝移植术的不同手术时期,患者的循环状态和肝肾功能都会发生变化。BIS监测系统能更好指导术中麻醉用药,增加麻醉安全性。Objective To apply bispectral index in anesthesia during piggyback orthotopic liver transplantation,and evaluate the patients＇ circulation,liver and renal function,and anesthetic effect to guide anesthetic drug administration at different phase of transplatation.Methods Clinical data of 48 patients underwent piggyback orthotopic liver transplantation in Chinese PLA 309 th Hospital from January 2014 to December 2016 were retrospectively analyzed.All patients were treated with static inhalation anesthesia to keep BIS value between 40 and 50.Then the characteristics of circulation,liver and kidney function,anesthetic drugs usage and urine volume were analyzed.Results All the 48 surgeries had been successfully completed with the total operating time of（8.6±1.2） h,among which,the pre-anhepatic phase was（3.6±0.7） h,the anhepatic phase was（1.5±0.2） h,and the hepatic reperfusion phase was（3.8±0.4） h.During the time from the pre-anhepatic phase to the hepatic reperfusion phase,the cardiac output and accumulation of lactic acid,and the liver and kidney function all increased,while the creatinine clearance decreased,and the urine firstly reduced and then increased gradually（P〈0.05,respectively）.The total amount of propofol was（169.9±36.5） ml with the pre-anhepatic phase infusion rate of（4.5±0.9） mg/（kg·h）,and then reduced to（2.1±0.7） mg/（kg·h） in the anhepatic phase.The dosage of propofol in hepatic reperfusion phase began to increase with the rate of（2.6±0.6） mg/kg·h（P〈0.05）.Conclusion The circulation,liver and kidney function of patients underwent piggyback liver transplantation will change at different transplantation phases.BIS monitoring system can be a better method to guide the drug usage and increase the safety of anesthesia during operation.

关 键 词：肝移植 脑电双频指数 麻醉 丙泊酚 

分 类 号：R614[医药卫生—麻醉学] R617[医药卫生—外科学]