【作者】 宋振国； 李锦城； 张凤文； 张广华； 郭东勇；

【机构】 天津医科大学附属肿瘤医院麻醉科；

【摘要】 目的:研究经典非转流原位肝移植手术各期的血流动力学变化和容量治疗。方法:经典非转流原位肝移植12例, 常规全麻诱导插管维持麻醉。术中根据动脉压(AP)、心率 (HR)、中心静脉压(CVP)、肺动脉压(PAP)、肺毛楔压 (PCWP)、心排血量(CO)指导输液。阻断门、腔静脉前10 分钟静脉输注贺斯500ml,无肝期开始后加快输注速度,血流动力学仍不稳定可给予血管活性药物。新肝期血流动力学波动明显时,可给予小量血管活性药并适当扩容。记录麻醉开始后、无肝前期结束时、无肝期开始、无肝期结束、新肝期开始和手术结束前的平均动脉压(MAP)、HR、CVP、平均肺动脉压(MAPP)、PCWP和CO。结果:无肝期开始时 CVP与其他时点差别具有非常显著性的意义(P<0．01),明显低干其他时点; MAPP、PCWP、CO与其他时点差别具有显著性的意义(P<0．05),低于其他时点。结论:无肝期阻断门腔静脉后回心血量骤减,引起血流动力学变化,以CVP 下降最为明显,随着血流经过右心、肺动静脉、左心和体循环大动脉,血流动力学的波动逐渐减弱。调控主要采用少量胶体液快速扩容并辅助血管活性药物的方法,胶体液以 HES200／0．5为首选,输注量一般不超过500ml。新肝期主要防治再灌注综合征。更多还原

【Abstract】 Objective: To investigate the change of hemodynamics and capacity therapy during classical unbypass orthotopic liver transplantation(OLT). Methods: 12 classical unbypass OLT patients were routine anesthesia induction.To accommodated the transfu-sional Velocity and volume according to the arterial pressure(AP), heart rate(HR), central venous pressure (CVP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure(PCWP) and cardiac output(CO) during the operation.6%HAES was given 10 minutes before portal vein and inferior vena cava were blocked up. Transfusional Velocity were accelerated in the anhepatic period and cardiovascular drugs were applied in which hemodynamics was unstable.Small doses of cardiovascular drugs and reasonable volume expansion therapy were applied when hemodynamics was unstable in the neohepatic period.To record the value of the mean arterial blood (MAP),HR,CVP,mean pulmonary artery pressure(MPAP), PCWP and CO in the time point of after anesthesia induction,the end of paleohepatic period,the beginning of anhepatic period, the end of anhepatic period, the beginning of neohepatic period and the end of operation. Results: The value of CVP in the time point of the beginning of anhepatic period was obviously lower than other time points(P<0.01)and the MAPP, PCWP, CO in the same time point was lower than other time points(P<0.05), too. Conclusion: After portal vein and inferior vena cava were blocked up the blood volume of returned heart was obviously decreased and caused hemodynamics’ s change in the anhepatic phase,which the descent of CVP was most obviously.The fluctuation of hemodynamics were gradually weaken following-up blood through right heart,pul-monary artery and vein,left heart and the large artery of the systemic circuIation.The treatment was small volume and quick velocity of the colloid volume expansion therapy and that HES200/0.5 was principal selection,which tatal volume was no more than 500ml. Reperfusion Syndrome was major prevented and cured in the neohepatic period.更多还原