【摘要】 目的观察肝硬化病人原位肝移植术中脑氧代谢的变化。方法16例拟行原位肝移植术的终末期肝硬化病人,年龄25～67岁,体重45～80kg,Child分级B级3例、C级13例,心功能Ⅰ或Ⅱ级,ASAⅢ或Ⅳ级。持续监测心输出量（CO）、平均动脉血压和体温；分别在术前（基础值）、切肝前10min、无肝期20min、新肝期30min和术毕采集桡动脉、肺动脉（混合静脉血）和左颈内静脉血,进行血气分析,记录血红蛋白、动脉、颈静脉的血氧饱和度（SaO₂、SjvO₂）、血氧分压（PaO₂、PjvO₂）,计算脑氧代谢和机体氧供指标：动脉血氧含量（CaO₂）、颈静脉血氧含量（CjvO₂）、动-颈静脉血氧含量差（Ca-jvO₂）、氧供（DO₂）、氧耗（VO₂）、脑氧摄取率（CERO₂）、脑血流/脑氧代谢率比值（CBF/CMRO₂）。结果与基础值比较,切肝前、新肝期及术毕CO升高,无肝期CO降低；术中Hb、CaO₂、Ca-jvO₂、CERO₂均降低,SjvO₂、CBF/CMRO₂升高；无肝期DO₂、VO₂、CjvO₂降低,其余时期DO₂升高,术毕VO₂升高；新肝期PaCO₂升高,pHa降低；无肝期和新肝期pH（?）和pHjv均降低,术中及术毕BEa、BE（?）和BEjv降低（P＜0.05）。结论肝硬化病人在肝移植围术期不存脑缺氧,脑氧摄取率降低。更多还原

【Abstract】 Objective To investigate the changes in cerebral oxygen metabolism during liver transplantation in patients with liver cirrhoses.Methods Sixteen ASAⅢorⅣpatients with liver cirrhoses（14 male,2 female）aged 25-67 yrs,weighing 45-80 kg undergoing liver transplantation were studied.Radial artery was cannulated for direct BP monitoring and blood sampling.Swan-Ganz catheter was placed in pulmonary artery （PA）via right internal jugular vein（IJV）for cardiac output（CO）monitoring and sampling mixed venous blood. Left IJV was cannulated and the catheter was advanced cephalad until jugular bulb for blood sampling.Anesthesia was induced with midazolam,fentanyl,propefol and vecuronium and maintained with isoflurane inhalation and intermittentⅣboluses of fentanyl and vecuronium.The patients were mechanically ventilated after tracheal intubation.PaCO₂ was maintained between 30-45 mm Hg.Blood samples were taken from radial artery,pulmonary artery and jugular bulb simultaneously for blood gas analysis before operation（T₀,baseline）,10 min before anhepatic phase（T₁）20 min after onset of anhepatic phase（T₂）,30 min after graft reperfusion（T₃）and at the end of operation（T₄）.Oxygen delivery（DO₂）,oxygen consumption（VO₂）,oxygen content of jugular bulb blood （CjvO₂）,cerebral arterial-venous oxygen content differences（Ca-jvO₂）cerebral oxygen extraction ratio（CERO₂） and CBF/CMRO₂ were calculated.Results The mean duration of operation was（364±51）min and the mean intraoperative blood loss was（1340±430）ml.CO was significantly increased before anhepatic phase（T₁）, during neohepatic phase（T₃）and at the end of operation（T₄）but decreased during anhepatc phase（T₂）as compared with the baseline value at T₀.Hb,CaO₂,Ca-jvO₂ and CERO₂ were all decreased while SjvO₂ and CBF/ CMRO₂ were increased during operation;DO₂,VO₂ and CjvO₂ were decreased during anhepatic phase;DO₂ was increased during other phases;VO₂ was increased at the end of operation as compared with the baseline（T₀）（P＜0.05 or 0.01）.Conclusion There is no cerebral oxygen deficiency during liver transplantation in patients with liver cirrhoses.更多还原