改良背驮式原位肝移植术无肝早期及新肝早期的麻醉处理

Anesthetic management of both the early anhepatic phase and the early reperfused phase of the innovative orthotopic liver taransplantation

目的 探讨改良背驮术肝移植无肝早期和新肝期的循环变化及调控。方法 13例终未期肝病患者接受改良背驮式肝移植术 ,观察无肝早期和新肝早期不同时间点的MAP、HR、CVP、PAP及尿量。结果 围术期血流动力学基本平稳。无肝早期MAP、CVP、PAP较无肝病期、麻醉前较轻度降低 ,HR轻度增快 ;新肝早期MAP、HR开始恢复到阻断期水平 ,CVP、PAP增高 ,本组病例CVP、PAP偏高。结论 改良背驮式肝移植无肝早期及新肝期早期及时补充血容量 ,应用血管活性药物 ,纠酸、补钙等措施 ,循环平稳。

Objective To study the hemodynamic changes and anesthetic management of both the early anhepatic phase and the early reperfused phase of the innovative orthotopic liver transplantation.Methods Thirteen end-stage liver disease patients received liver transplantation.MAP,HR,CVP,PAP and urinary output were continuously monitored.Results The hemodynamics was stable in the perioperated phase.MAP,CVP and PAP mildly decreased while HR mildly increased in the early anhepatic phase.In the early reperfused phase,CVP and PAP increased while MAP and HR were as same as before the anhepatic phase.Conclusion The volum replacement therapy,the rational use of anti-acidosis and the calcium suppplement were beneficial to maintaining hemodynamic stability in the early anhepatic phase or the early reperfused phase of the innovative orthotopic liver transplantation.