原位肝移植术麻醉管理的临床研究  

The Clinical Study on Anesthetic Management of Orthotopic Liver Transplantation

作　　者：方明[1] 张中军[1] 顾丽莉[1] 项舒玮[1] 李荣[1] 彭玉梅[1] 华海峰[1] 

机构地区：[1]无锡市第三人民医院麻醉科,江苏214041

出　　处：《交通医学》2003年第3期272-274,共3页Medical Journal of Communications

摘　　要：目的 :探讨原位肝移植术的麻醉管理。方法 :采用静吸复合全身麻醉 ,术中加强监测血液动力学、血气、血生化、凝血功能、体温、血糖、出血量和尿量。结合肝移植术无肝前期、无肝期、新肝期的特点 ,给予相应的麻醉处理。结果 :血液动力学和酸碱平衡在无肝期和新肝早期出现剧烈改变 ;围术期电解质变化突出在血钾和血钙上 ;无肝期血糖升高 ,新肝期血糖逐渐下降 ;凝血功能有一定程度的紊乱 ,需及时补充凝血因子 ,适当使用止血药物 ;术中体温变化明显 ,需及时处理。结论 :肝移植麻醉中维持血流动力学稳定、随时纠正水电解质和酸碱平衡的紊乱 ,加强血气、生化及凝血功能的检测与调控是手术顺利完成的关键。Objective:To investigate the perioperative changes and anesthetic management of adult patients in orthotopic liver transplantation.Methods:General anesthesia was conducted. Hemodynamics, blood gas, blood biochemics, coagulation function, blood glucose, body temperature, urinary output and bleeding output were monitored during the operation. According to the characteristics of pre-anhepatic phase, anhepatic phase and neohepatic phases, corresponding anesthetic management measures were given.Results:Hemodynamics changes and acid-based disturbance may occur greatly during anhepatic phase and early reperfusion phase. Blood potassium and blood calcium were of significant difference compared with those of preoperation. Disturbance of coagulation function to a certain degree occurred, supplementation of coagulation factors and proper use of hemostatic drugs were needed. During the operation a marked change in body temperature took place, timely corrective measures were required. The blood glucose level was higher than normal during pre-anhepatic phase, and gradually decreased during the neohepatic phase.Conclusions:Attention should be paid to the anesthetic management and monitoring during different phases of OLT. Maintaining hemodynamics stability, correcting fluid electrolyte and acid-base disturbance in time, reinforcing the monitoring and adjustment of blood gas, biochemical alterations and coagulation function are the keys to successful operation.

关 键 词：原位肝移植术 麻醉管理 静吸复合全身麻醉 监测 血液动力学 围麻醉期 

分 类 号：R657.3[医药卫生—外科学] R614.24[医药卫生—临床医学]