活体小肠移植术的麻醉管理  

Anesthesia management of living small bowel transplantation

作　　者：郑跃英[1] 户雪雪 郭少惠[1] 徐姗姗 黄素琴[1] 祝胜美[1] Zheng Yueying;Hu Xuexue;Guo Shaohui;Xu Shanshan;Huang Suqin;Zhu Shengmei(Department of Anesthesiology,the First Affiliated Hospital,College of Medicine,Zhejiang University,Hang-zhou 310006,China)

机构地区：[1]浙江大学医学院附属第一医院麻醉科,杭州310006

出　　处：《中华麻醉学杂志》2021年第7期827-830,共4页Chinese Journal of Anesthesiology

摘　　要：目的活体小肠移植术的麻醉管理总结。方法首次行活体、同种异体部分小肠移植术患者7例,分析麻醉手术过程中血流动力学、血气分析指标、体温及术中输血、输液情况,追踪术后转归。结果6例患者存活并顺利出院,死亡1例。术后手术室内气管导管拔除率71%。与解剖分离期比较,血管吻合期和肠管重建期Hb和肠管重建期Ca2+浓度降低,血管吻合期血糖浓度升高(P<0.05或0.01);与血管吻合期比较,肠管重建期血糖浓度升高(P<0.05)。7例患者术中输注晶体液(57±30)ml/kg,胶体液以20%白蛋白为主,输注(15±13)ml/kg,多用于解剖分离期和血管吻合期。结论活体小肠移植术成功的条件是术前充分评估与准备,静吸复合麻醉联合术毕腹横肌平面阻滞,术中合理输注胶体,并辅以血管活性药物维持血流动力学平稳,监测血气、体温并积极调整电解质、内环境及体温稳定,可较好地维持活体小肠移植术受体患者围术期生命体征平稳,术毕尽早拔除气管导管,减少术后并发症。Objective To summarize the anesthesia management of living small bowel transplantation.Methods Severn patients undergoing living and allogeneic small bowel transplantation for the first time were selected.The intraoperative hemodynamics,indexes of blood gas analysis,body temperature and blood transfusion and volume of liquid infused were analyzed.Postoperative outcomes were tracked.Results Six cases survived and were successfully discharged from hospital successfully,and one patient died.In the operation room,71%patients were successfully extubated after surgery.Compared with the values during anatomical separation period,Hb during vascular anastomosis and intestinal reconstruction periods and concentration of Ca2+during intestinal reconstruction period were significantly decreased,and the blood glucose concentration during vascular anastomosis period were increased(P<0.05 or 0.01).Compared with the values during vascular anastomosis period,the blood glucose concentration was increased significantly during intestinal reconstruction period(P<0.05).Crystalloid solution(57±30)ml/kg and colloid solution which mainly containing 20%albumin(15±13)ml/kg were infused mainly during anatomical separation and vascular anastomosis periods in all the patients.Conclusion The condition of successful living small bowel transplantation is fully evaluation and preparation before surgery.Intravenous-inhalational anesthesia combined with transverses abdominis plane block and rational infusion of colloid solution with vasoactive drugs to maintain hemodynamics stability and monitor blood gas,body temperature,active adjustment of electrolytes and internal environment and stable body temperature can be helpful in maintaining perioperative stable vital signs during the perioperative period,removing the tracheal tube early at the end of surgery,and reducing the development of postoperative complications in patients undergoing living small bowel transplantation.

关 键 词：器官移植 麻醉 

分 类 号：R614[医药卫生—麻醉学]