【摘要】 目的分析肝硬化性门肺高压患者肝移植术中体、肺循环血液动力学的变化。方法 8 例肝硬化性门肺高压患者［平均肺动脉压(MPAP)大于25mmHg］为门肺高压组,年龄50～63岁,体重 45～80kg,8例肝硬化未合并门肺高压患者为对照组,年龄32～65岁,体重52～78kg。两组心功能Ⅰ或Ⅱ级,ASAⅡ～Ⅳ级,均接受改良背驮式肝移植术,观察术中体、肺循环血液动力学的变化。结果与对照组比较,门肺高压组术前 MPAP、肺循环阻力指数(PVRI)升高(P＜0.05)。与术前相比,无肝期两组心脏指数(CI)、MPAP、肺动脉楔压(PAWP)和中心静脉压(CVP)降低,体循环阻力指数(SVRI)升高；新肝期 MPAP、CI、CVP 升高。门肺高压组新肝期 PVRI 变化幅度高于对照组(P＜0.05)。结论肝硬化性门肺高压患者新肝期肺动脉压力和肺血管阻力增加更明显。更多还原

【Abstract】 Objective To investigate the changes in systemic and pulmonary hemodynamics in patients with liver cirrhosis and portopulmonary hypertension（PPH）during liver transplantation.Methods Eight patients with liver cirrhosis and PPH（5 male,3 female）aged 50-63 yr weighing 45-80 kg were included in PPH group. Another 8 liver-cirrhotic patients without PPH served as control group.The patients were premedicated with intramuscular phenobarbital 0.1 g and atropine 0.5 mg.Anesthesia was induced with midazolam 3-5 mg,fentanyl 0.15-0.2 mg,propefol 1 mg·kg^-1 and vecuronium 0.1 mg·kg^-1 and maintained with 0.5%-3% isoflurane inhalation and intermittent Ⅳ boluses of fentanyl and vecuronium.The patients were mechanically ventilated after tracheal intubation.P_ETCO₂ was maintained at 30-45 mm Hg.Right subclavian vein was cannulated for fluid and drug administration and blood transfusion.Radial artery was cannulated for BP monitoring.Swan-Ganz catheter was placed via right internal jugular vein.BP,CVP,MPAP,PAWP,CI,PVRI and SVRI were monitored and recorded before operation（baseline）,during preanhepatic phase,at 3 and 30 min of anhepatic phase and 3,7, 15,60 min of neohepatic phase and at the end of operation.Results（1）The two groups were comparable with respect to fluid balance,the amount of vasoactive drugs used during anhepatic and neohepatic phase,duration of anhepatic phase and operation.（2）MPAP and PVRI were significantly higher before operation in PPH group than in control group.（3）CI,MPAP, PAWP and CVP were siguificanfly decreased during anhepatic phase as compared to the baseline values（before operation）in both groups and then gradually returned to and even exceeded the baseline values during neohepatic phase.（4）During neohepatic phase PVRI in PPH group was significantly increased as compared to the baseline value and was significantly higher than that in control group.Conclusion MPAP and PVRI are significantly increased during neohepatic phase in patients with PPH and need to be treated.更多还原