【摘要】 目的:观察非转流原位肝移植患者无肝期循环和氧供氧耗改变并分析评价处理方法。方法:经典非转流原位肝移植患者20例行静吸复合全麻,麻醉前左桡动脉穿刺置管监测血压,气管插管后经右颈内静脉置入六腔Swan-ganz导管连续监测体循环和肺循环血流动力学参数、中心血温等。采集下腔静脉阻断前5 min(T0)、阻断后5 min(T1)、阻断后20 min(T2)、开放前5 min(T3)桡动脉和肺动脉血行血气分析,分别记录氧分压(PaO2、PvO2)、血氧饱和度(SaO2、SvO2),记录各时点桡动脉平均血压(MAP)、心率(HR)、中心静脉压(CVP)、心输出量(CO)。计算心脏指数(CI)、每搏指数(SVI)、体循环阻力(SVR)、动静脉血氧含量(CaO2,CvO2)、氧供量(DO2I)、氧耗量(VO2I)和氧摄取率(ERO2)。结果:T1与T0比较CI、SVI、MAP明显下降(P<0.01),SVR升高(P<0.05);DO2I降低(P<0.01),VO2I和ERO2增加(P<0.01)。阻断期间CO、CI呈下降趋势;T2时DO2I、VO2I比T1下降(P<0.01)。结论:经典非转流手术患者的无肝期处理不但要考虑循环改变,还要注意氧供需平衡的变化,避免出现失衡,以保证患者的安全。更多还原

【Abstract】 Objective: To observe the changes of circulation and oxygen delivery/consumption during anhepatic phase of classic orthotopic liver transplantation (OLT) without bypass and estimate the anesthetic process. Methods: Twenty patients undergoing OLT without bypass under combined general anesthesia were enrolled in this observation. Left radial artery was cannulated and Swan-Ganz catheter was placed in the pulmonary artery via right internal jugular vein to monitor circulation continuously and core blood temperature. Mean artery blood pressure(MAP), heart rate(HR), central venous pressure(CVP) and cardiac output(CO) were recorded at several time points such as 5 min before interruption of inferior vena cava (T0), 5 min(T1),20 min(T2) after interruption and 5 min before unclamping of inferior vena cava(T3). At the same time blood samples were taken from radial and pulmonary artery for blood gas analysis to record oxygen partial pressure(PaO2,PvO2) and saturation of blood oxygen(SaO2,SvO2) and calculate cardiac index(CI),stroke volume index(SVI), system vascular resistance(SVR); oxygen delivery (DO2I)and oxygen consumption(VO2I) were also calculated at these time points. Results: CI, SVI, MAP and DO2I were decreased significantly (P<0.01) at T1 compared with T0, SVR was increased (P<0.05) and VO2I, ERO2 were increased too (P<0.01) at the same time point. With the process of anhepatic phase there was the decreasing trend in CO and CI. At T2 compared with T1 DO2I and VO2I were decreased (P<0.01). Conclusion: During the anhepatic phase of classic OLT without bypass the balance of oxygen delivery and oxygen consumption is as important as the change of hemodynamics. For the safety of patients the imbalance should be avoided.更多还原