【摘要】 目的观察背驮式原位肝移植术患者术中不同时期血液动力学的变化。方法患者15例,男12例,女3例,年龄8～75岁,体重22.5～75kg。均因终末期肝病在静吸复合全身麻醉下行背驮式肝移植术。术中对患者HR、ECG、PETCO2、SpO2、有创动脉压、平均肺动脉压(MPAP)、肺毛细血管楔压(PCWP)、中心静脉压(CVP)进行监测,并用热稀释法监测心排血量(CO)、心脏指数(CI)、每搏量(SV)、外周血管阻力(SVR)。对手术切皮后30min、无肝期30min及新肝期30min三个时点的血液动力学指标进行统计分析。结果各时点MAP及CVP无明显变化;无肝期HR、SVR明显高于切皮后30min和新肝期30min(P<0.05或P<0.01);无肝期MPAP、PCWP、CO、SV、CI均明显低于切皮后30min和新肝期30min(P<0.01)。结论背驮式肝移植术无肝期MAP能相对稳定,但其他血液动力学指标的变化仍较明显,应加强此术式中血液动力学的监测和管理。更多还原

【Abstract】 Objective To investigate the changes of systemic hemodynamics during piggyback orthotopic liver transplantation（POLT）. Methods Fifteen end-stage hepatopathy patients （male 12, female 3, 8 - 75 years old） received POLT. ECG, P ETCO₂, SpO₂ and hemodynamics such as cardiac output（CO）, cardiac index（CI）, stroke volume（SV）, systemic vessels resistence（SVR） were monitored through Swan-Ganz catheter at 30min after incision, 30min after anhepatic phase,30min after nomohepatic phase.Results Mean blood pressure（MAP） remained stable during operation. Heart rate（HR） accelerated at anhepatic phase（P<0.01）,and SVR increased significantly during anhepatic phase（P<0.05）,but CVP, PA, PCWP,CO, CI and SV decreased significantly simultaneously. Conclusion Although MAP was relatively stable during POLT, the changes of hemodynamics were still significant,and closely monitoring and management are needed.更多还原