移植肝门脉血流恢复后肝静脉血成分变化及其对内环境的影响  

The change of components in hepatic venous blood after portal vein reperfusion and its effects on systemic homeostasis during orthotopic liver transplantation in man

作　　者：李士通[1] 汪正平[1] 王莹恬[1] 徐国辉[1] 颜涛[1] 庄心良[1] 

机构地区：[1]上海交通大学附属第一人民医院麻醉科,上海市200080

出　　处：《临床麻醉学杂志》2004年第4期198-200,共3页Journal of Clinical Anesthesiology

基　　金：上海市临床医学中心项目(ZX01A06)

摘　　要：目的 观察非转流经典原位肝移植术门静脉和下腔静脉的完全阻断和开放导致的内环境紊乱。方法 非转流经典原位肝移植患者70例,于麻醉前、门静脉阻断前、门静脉开放前和门静脉开放后5min采集患者的动脉血,并于门静脉开放后采集肝静脉血,监测Hb、pH、PaCO_2、BE、PaO_2、血钠、血钾、血钙、血乳酸(LA)、血糖(BG)以及MAP、HR的变化。结果 手术期间循环系统变化明显,表现为腔静脉阻断期间和开放后MAP下降、HR增快和Hb降低。门静脉开放前PaCO_2升高,LA升高,pH和BE下降;开放后5min PaCO_2进一步升高,BE个体间差值明显加大,在—11～9mmol/L之间;开放后5min时血钾个体间波动也在2.6～6.1 mmol/L;同时,BG升高近一倍,LA也大幅升高。肝静脉血严重高钾、高CO_2和钠、钙、pH和BE显著降低,血钾水平最低为10mmol/L,最高达到72mmol/L。结论 非转流原位肝移植术中,门静脉和下腔静脉开放后,受肝静脉血成分的影响,出现明显内环境紊乱,显著低钙、高CO_2、高血糖和乳酸蓄积,而血钾和酸碱平衡变化的个体差异极大,需适时监测并纠正。Objective To investigate the components of hepatic venous blood after portal vein reperfusion and its effects on systemic homeostasis in orthotopic liver transplantation(OLT)without anhepatic veno-venous bypass. Methods The hemodynamics,blood gas,blood glucose and lactate concentrations were determined before anesthesia, before clamping of the portal vein, before unclamping of the portal vein,and at 5 min after portal vein reperfusion. In addition, hepatic venous blood sample was also collected and monitored after portal vein reperfusion. Results There were significantly changes in MAP, HR and Hb concentration during anhepatic period, especially in clamping and unclamping the vena cava. PaCO_2 and blood lactate increased, pH and BE decreased before unclamping the portal vein. At 5 min after portal vein reperfusion,PaCO_2 increased further and blood glucose and lactate concentration increased seriously. Serum potassium level varied from 2.6 to 6.1 mmol/L,and BE from—11 to 9 mmol/L. There were tremendous increases in potassium, PaCO_2,glucose and lactate concentration, and severe decreases in sodium, calcium, pH and BE in hepatic vein blood samples. Conclusion During orthotopic liver transplantation without veno-venous bypass, the systemic homeostasis was influenced seriously by hepatic vein blood after reperfusion of the transplanted liver.

关 键 词：肝移植 门脉血流 肝静脉血 内环境 手术 

分 类 号：R657.3[医药卫生—外科学]