8例原位肝移植术血液动力学的调控

The hemodynamic adjustment in 8 orthotopic liver transplantation patients

目的:探讨原位肝移植术中应用血管活性药和血液回收技术对维持血液动力学相对稳定、减少异体血输注、避免容量超载的作用。方珐:8例重型肝病患者在非静脉-静脉转流方式下行原位肝移植术,围术期用1: 1多巴胺和速尿1-10.0μg·kg-1·min-1静脉泵入,新肝期恢复供血再灌注即刻单次输注去氧肾上腺素和/或肾上腺素50～100 μg,应用血液回收仪回收自体血,必要时单次输注速尿20-40 mg,使尿量>50-100 ml/h,分析术前、无肝前期、无肝期、新肝期、术毕各期血液动力学变化特点及围术期血红蛋白(Hb)及红细胞压积(Hct)的变化。结果:无肝期、新肝期收缩压,舒张压的变化与术前和元肝前期比较差异均无统计学意义(P>0.05);无肝期5 min 时中心静脉压(CVP)明显低于术前(P<0.05),无肝期5 min、新肝期5 min及30 min和术毕时心率(HR)明显高于术前(P<0.05),无肝期5 min时HR明显高于无肝前期(P<0.05);术前、术中、术后Hct变化差异无统计学意义(P>0.05);术中Hb明显高于术前(P<0.05)。结论:肝移植围术期合理进行输血、输液,使用血液保护技术,适量应用血管活性药物,不仅避免容量超载所致的各种并发症,而且确保在非静脉-静脉转流条件下维持血液动力学的相对稳定。

Objective： To observe changes of hemodynamics and effects of blood preserve technique and adrenergic agonists on maintaining stable hemodynamics during orthotopic liver transplantation （OLT） without veno-venous bypass. Methods： Eight patients with severe hepatism were performed OLT by general anesthesia without veno-venous bypass. 1：1 Dopamine and furosemide （1～10.0μg·kg^-1·min^-1） was given during perioperation. Adrenaline and/or phenylephrine（50～100μg） were given by intravenous bolus as soon as blood reperfusion in neohepatic stages. Blood cell saver was used in neohepatic stages. According to urine output, we gave furosemide 20～40 mg by bolus to make urine output greater than 50～100 ml/h. Changes of hemodynamics and blood routin in each period were analysised. Results： Changes of SBP and DBP in each period were no significant difference （P〉0.05）. Changes of hemodynamics in ahepatic and neohepatic stages were mainly compensated by increase of heart rate and reduction of CVP （P〈0.05）. Changes of Hct in each period was no significant difference （P〉0.05）, while change of Hb during operation was greater than that of preoperation （P〈0.05）. Conclusions： Hemodynamic stability is maintained during OLT without veno-venous bypass. Infusing fluid and blood with using blood preserve technique and adrenergic agonists reasonably, which not only avoided blood volume overload, but also maintained hemodynamic stability without veno-venous bypass.