原位肝移植术中血流动力学、内稳态变化及麻醉处理

Changes of hemodynamics and homeostasis in orthotopic liver transplantation and anesthetic management

目的:探讨原位肝移植(orthotop ic liver transp lantation,OLT)围手术期的血流动力学、内稳态变化和麻醉处理。方法:终末期肝病患者14例,采用气管内静吸复合全麻。右心置入Swan-Ganz导管监测不同时期血流动力学变化,同时监测内环境各项指标的变化。结果:血流动力学变化显示,在无肝期肺小动脉楔压(pu lmonary arterial wedge pressure,PAWP)、平均动脉压(MAP)、中心静脉压(central venous pressure,CVP)较术前明显下降(P<0.01);在腔静脉开放时CVP较术前明显升高(P<0.01)、PAWP升高(P<0.05)、MAP下降(P<0.01);术毕继续维持较高水平平均肺动脉压(MPAP)(P<0.01);心输出量在腔静脉阻断及开放时较术前降低(P<0.05)。结论:血流动力学主要发生于无肝期和新肝早期,此期间加强监测、及时处理,可得到基本纠正。

Objective：To investigate the changes of hemodynamies and homeostasis during orthotopie liver transplantation and the anesthetic management. Methods：Fourteen patients with the chronic end-stage liver disease underwent orthotopic liver transplantation under combined intravenous-inhalational anesthesia. The Swan-Ganz tube was inserted to the right ventricle to observe the changes of hemedynaraics and homeostasis at different stages. Results： All the patients received the operation smoothly. At anhepatic stage, pulmonary arterial wedge pressure（ PAWP）, mean systemic arterial pressure （MAP） and central venous pressure （CVP） decreased significantly compared with those before operation（ P 〈 0.01 ）, but at the point of unelamping vena eava, PAWP and CVP increased significantly,while MAP decreased（ P 〈 0.01 ）. Mean pulmonary arterial pressure （MPAP） kept at a high level at the end of operation （P 〈0.01 ）. cardiac output （CO） was lower at the point of clamping or unclamping vena cava than before operation （P 〈 0.05 ）. Conclusions：The changes of homodynamics mainly occur at anhepatic and early neohepatic stage. Comprehensive treatment and timely management may check the changes.