[1]赵艳,蒋建渝,张利萍,等.非转流原位肝移植不同术式对麻醉管理的影响[J].中国微创外科杂志,2008,08(1):11-15.
　Zhao Yan,Jiang Jianyu,Zhang Liping,et al.Effects of Different Ways of Orthotopic Liver Transplantation without Venovenous Bypass on Anesthetic Management[J].Chinese Journal of Minimally Invasive Surgery,2008,08(1):11-15.
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非转流原位肝移植不同术式对麻醉管理的影响()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
08
期数:
2008年1期
页码:
11-15
栏目:
出版日期:
2008-10-22

文章信息/Info

Title:
Effects of Different Ways of Orthotopic Liver Transplantation without Venovenous Bypass on Anesthetic Management
作者:
赵艳; 蒋建渝; 张利萍; 徐德军; 南兴东; 张梁
北京大学第三医院麻醉科，北京100083
Author(s):
Zhao Yan;  Jiang Jianyu;  Zhang Liping;  et al.
Department of Anesthesiology, Peking University Third Hospital, Beijing 100083, China
关键词:
肝移植; 非转流; 麻醉
Keywords:
Liver transplantation; No bypass; Anesthesia
分类号:
R614.2;R657.3
文献标志码:
A
摘要:
目的比较非转流背驮式与经典式原位肝移植术（orthotopic liver transplantation, OLT）对麻醉管理的影响。方法回顾性分析2003年11月 ~ 2006年12月我院50例非转流OLT的临床资料，其中背驮式（A组）和经典式（B组）各25例，比较2组患者在围术期血流动力学、凝血状况、肝肾功能、内环境的改变及液体治疗等方面的异同。结果无肝期即刻A组平均动脉压 (68±6) mm Hg显著高于B组(64±5) mm Hg (t=2.561, P=0.014)，A组中心静脉压 (5.4±3.3) mm Hg高于B组(3.5±2.3) mm Hg (t=2.362, P=0.022)，A组心脏指数 (3.7±0.8)L·min-1·m-2显著高于B组(3.2±0.6) L·min-1·m-2(t=2.500, P=0.016)。新肝期即刻A组平均动脉压 (66±6) mm Hg明显高于 B组 (62±5) mm Hg (t=2561, P=0.014)，A组中心静脉压(8.4±4.0) mm Hg与B组(10.6±4.2) mm Hg无统计学差异(t=-1.897, P=0.064)。再灌注综合征的发生率A组(2/25，80%)低于B组(8/25，320%)（χ2=4.500, P=0.034）。新肝初期A组血液pH 7.34±0.05显著高于B组7.31±0.04(t=2.343, P=0.023)。A组碱剩余（-4.9±2.3）mmol /L亦高于B组（-6.3±2.3）mmol /L (t=2.152, P=0.036)。2组凝血和肝肾功能、术中出入量和成分输血的比较差异无统计学意义(P>005)。血管活性药物用量Ａ组显著少于Ｂ组（P<0.05）。结论非转流背驮式OLT较经典式OLT的血流动力学和酸碱平衡相对稳定。2种术式OLT术中均需要加强对血流动力学、内环境、凝血和肝肾功能的监测与调整，及有针对性的液体管理。
Abstract:
ObjectiveTo compare the effects of piggyback and classic orthotopic liver transplantation (OLT) without venovenous bypass on anesthetic management.MethodsA retrospective review was conducted on the clinical data of 50 cases of OLT without venovenous bypass performed from November 2003 to December 2006, including 25 piggyback (group A) and 25 classic (group B) OLT. The perioperative hemodynamics, hemostatic conditions, hepatic and renal functions, changes of internal environment, and fluid therapy were compared between the two groups.ResultsAt the beginning of anhepatic stage, the mean arterial pressure (MAP), central venous pressure (CVP), and cardiac index (CI) in the group A were significantly higher than those in the group B ［MAP: (68±6) mm Hg vs (64±5) mm Hg; t=2.561, P=0.014. CVP: (5.4±3.3) mm Hg vs (3.5±2.3) mm Hg; t=2.362, P=0.022. CI: (3.7±0.8) L· min-1· m-2 vs (3.2±0.6) L· min-1· m-2;t=2.500, P= 0.016］. At the beginning of neohepatic phase, the MAP in the group A was significantly higher than that in the group B ［(66±6) mm Hg vs (62±5) mm Hg; t=2.561,P=0.014］, while the CVP was similar between the two groups ［(8.4±4.0） mm Hg vs (10.6±4.2) mm Hg; t=-1.897,P=0.064］. The morbidity rate of reperfusion syndrome in the group A was significantly lower than that in the group B (80% vs 320%, χ2=4.500, P=0.034).At the early neohepatic stage, the blood pH and base excess (BE) values in the group A were significantly higher than those in the group B ［pH: 7.34±0.05 vs 7.31±0.04; t=2.343, P=0.023. BE: (-4.9±2.3) mmol /L vs (-6.3±2.3) mmol /L; t=2.152, P=0.036］.No significant differences were detected in the hemostatic states, hepatic and renal functions, intraoperative blood loss, urine output, fluid replacement, and component transfusion during OLT between the two groups (P>0.05). The requirement of vasoactive drugs in the group A was significantly smaller than that in the group B (P<0.05).ConclusionsThe hemodynamics and acidbase balance are relatively stable in the piggyback OLT compared to the classic OLT without venovenous bypass. Monitoring and regulation of hemodynamics, internal environment, coagulation state, hepatic and renal functions, and fluid administration should be emphasized during the OLT by using both the techniques.

参考文献/References:

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更新日期/Last Update: 2013-10-22