原位肝移植术中血流动力学、内稳态变化及麻醉处理

    Changes of hemodynamics and homeostasis in orthotopic liver transplantation and anesthetic management

    • 摘要: 目的: 探讨原位肝移植(orthotopic liver transplan tation,OLT)围手术期的血流动力学、内稳态变化和麻醉处理。方法: 终末期肝病患者14例,采用气管内静吸复合全麻。右心置入Swan-Ganz导管监测不同时期血流动力学变化,同时监测内环境各项指标的变化。结果: 血流动力学变化显示,在无肝期肺小动脉楔压(pulmonary arterial wedge pressure,PAWP)、平均动脉压(MAP)、中心静脉压(central venous pressure,CVP)较术前明显下降(P<0.01);在腔静脉开放时CVP较术前明显升高(P<0.01)、PAWP升高(P<0.05)、MAP下降(P<0.01);术毕继续维持较高水平平均肺动脉压(MPAP)(P<0.01);心输出量在腔静脉阻断及开放时较术前降低(P<0.05)。结论: 血流动力学主要发生于无肝期和新肝早期,此期间加强监测、及时处理,可得到基本纠正。

       

      Abstract: Objective: To investigate the changes of hemodynamics and homeostasis during orthotopic liver transplantation and the anesthetic management.Methods: Fourteen patients with the chronic end-stage liver disease underwent orthotopic liver transplantation under combined intravenous-inhalational anesthesia.The Swan-Ganz tube was inserted to the right ventricle to observe the changes of hemodynamics and homeostasis at different stages.Results: All the patients received the operation smoothly.At anhepatic stage,pulmonary arterial wedge pressure(PAWP),mean systemic arterial pressure(MAP) and central venous pressure(CVP) decreased significantly compared with those before operation(P<0.01),but at the point of unclamping vena cava,PAWP and CVP increased significantly,while MAP decreased(P<0.01).Mean pulmonary arterial pressure(MPAP) kept at a high level at the end of operation(P<0.01).cardiac output(CO) was lower at the point of clamping or unclamping vena cava than before operation(P<0.05).Conclusions: The changes of homodynamics mainly occur at anhepatic and early neohepatic stage.Comprehensive treatment and timely management may check the changes.

       

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