肝移植患者围手术期呼吸力学参数监测

Parameters monitoring of mechanics of respiration during perioperative period in patients undergoing orthotopic liver transplantation

目的观察原位肝移植患者围手术期呼吸力学参数的变化。方法选取根据美国麻醉协会分级(ASA)为Ⅱ～Ⅲ级的终末期肝病患者30例行非静脉转流下原位肝移植术,监测患者围手术期及术后1d的平均气道阻力、吸气峰压、呼气峰流速、肺顺应性、呼吸功和呼吸驱动力等力学指标,并观察术后呼吸系统并发症的发生情况。结果术中平均气道阻力自进腹后下降,新肝期5min下降明显(P<0.05),术后较术前增加,但差异无统计学意义;术中呼气峰流速和肺顺应性进腹开始逐渐增大,无肝期及新肝期增加明显(P<0.05),而术后则较术前显著降低(P<0.05);术中呼吸功进腹后有所下降,无肝期5min、30min和术后下降明显(P<0.05);呼吸驱动力在术中显著低于术前(P<0.05),术后恢复至术前水平。术后出现呼吸系统并发症35例次,包括胸腔积液、肺不张、肺动脉高压、肺间质水肿和肺部感染等。结论患者非静脉转流下原位肝移植手术前后呼吸力学参数发生显著改变。术后给予一定时期的呼吸机支持是保证肺功能恢复的必要措施。

Objective To investigate the changes in mechanics of respiration during perioperative period in patients undergoing orthotopic liver transplantation （OLT） without venovenous bypass. Methods Thirty patients of grade Ⅱ-Ⅲ according to the American Society of Anesthesiologists （ASA） classification, undergoing orthotopic liver transplantation without venovenous bypass, were included in this study. The respiratory parameters measured perioperatively included average airway resistance, peak inspiratory pressure, peak expiratory flow rate, dynamic compliance, work of breathing and respiratory drive. The complications of respiratory system during postoperative period were observed. Results Average airway resistance was decreased after abdominal cavity opening, decreased significantly at 5 min new hepatic phase and increased postoperatively. Peak expiratory flow rate and dynamic compliance were increased gradually after induction and increased significantly at anhepatic phase and new hepatic phase hut decreased significantly on the first day postoperatively. Work of breathing was decreased after induction and decreased significantly at anhepatic phase and postoperative period. There was no significant difference in peak inspiratory pressure during operation. Compared with the values preoperation, the respiratory drive was decreased significantly during anhepatic phase and new hepatic phase. Total 35 times of postoperative respiratory complications occurred, which included pleural effusion, atelectasis, pulmonary artery hypertension, pulmonary interstitial edema and pnermonia. Conclusions There are obvious changes in respiratory mechanics during perioperative period of OLT, especially in postoperative period. Mechanical respiratory support is essential for oatients until resoiratory function recovers.