^(99)Tc^m标记红细胞检测肝功能衰竭患者肝移植术中的有效血容量变化

Using ^(99)Tc^m marking RBC in vitro to detect effective blood volume change in patients suffering from liver function failure during transplantation

目的研究肝功能衰竭患者肝移植术中有效血容量变化情况。方法利用体外法99Tcm标记红细胞(RBC)检测22例施行肝移植手术的肝功能衰竭患者术中有效血容量的变化。时相点:手术开始30 m in(T1),无肝期90 m in(T2),新肝期30 m in(T3),手术关闭腹腔(T4)。结果尽管HCT、HR、SAP、CVP、MPAP、PCWP等指标保持相对稳定的情况下,BV仍然存在较为显著的变化,T2、T3、T4和T1相差有显著性意义(P<0.05),T3、T4和T2之间相差有显著性意义(P<0.05)。结论在肝功能衰竭患者施行肝移植术中,在无肝期90 m in、新肝期30m in期间机体将产生较为显著的血容量异常分布,大量晶体将进入第三间隙并成为术后肺水肿、肺部感染、肾衰等的诱导因素,应该及时进行相应处理。

Objective To investigate the change of effective blood volume in patients suffering from liver function failure during transplantation. Methods ^99Tc^m marking RBC in vitro was used to detect the change of effective blood volume of 22 patients who underwent liver transplantation in our hospital from Sep 2004 to Oct 2005. The effective blood volume was detected 30 min after operation beginning （T1）, 90 min in anhepatic phase （T2）, 30 min in neo-hepatic phase （T3）, when abdominal cavity was closed （T4）. Results When HCT, HR, SAP, CVP, MPAP, PCWP were kept steady, the blood volume （BV） of T2, T3 and T4 was significantly lower than T1 （ P 〈 0.05 ）, and BV of T3 and T4 significantly lower than T2 （P 〈 0.05 ）. Conclusion During the liver transplantation, there is obvious abnormal distribution of BV in patients between T2 and T3. A great deal of crystal gets into third space and induce pulmonary edema, pulmonary infection, renal failure, which should be treated in time.