原位肝移植围术期混合静脉血氧饱和度改变及临床意义

Change in mixed venous oxygen saturation in patients in perioperative periods of orthotopic liver transplantation and its clinical implication

目的观察原位肝移植围术期混合静脉血氧饱和度(SvO2)的变化及其临床意义。方法20例终末期肝硬化患者接受原位肝移植术。采用心排仪持续监测围术期SvO2、氧供(DO2)、氧耗(VO2)、氧摄取率(ERO2)、体温、心排血量(CO)、平均动脉压(MAP)的变化,分析肝移植围术期SvO2与上述各指标的相关性。结果SvO2在无肝期前15min较术前增高(P<0.05),在无肝期30min较无肝期前15min显著降低(P<0.05),在新肝期30min和术毕较术前均显著增高(P均<0.05)。机体DO2、VO2在无肝期30min均显著降低(P均<0.05),而在进入新肝期后均显著增高(P均<0.05);ERO2进入新肝期后显著增加(P<0.05)。SvO2在各时间点均与VO2有显著相关性(P均<0.05),而与DO2、血红蛋白无相关性(P均>0.05);SvO2术前与CO有显著相关性(P<0.05),其他时间点均无相关性(P均>0.05)。结论原位肝移植围术期持续监测SvO2对于改善氧代谢具有重要的临床意义。

Objective To observe the changes in mixed venous oxygen saturation （SvO2） during perioperative periods of orthotopic liver transplantation （OLT）, and explore its clinical significances. Methods Twenty patients in terminal stage of hepatic cirrhosis were scheduled for OLT under combined general anesthesia. Vigilance monitor （Edwards, USA） was employed to monitor perioperative SvO2, oxygen delivery （DO2）, oxygen consumption （VO2）, oxygen extraction rate （ERO2） and body temperature, cardiac output （CO）, and mean arterial blood pressure （MAP）. Results Compared with the preoperative stage, SvO2 elevated during 15 minutes of anhepatic stage （P〈0.05）, but decreased significantly during 30 minutes compared to that during 15 minutes of anhepatic stage. Then it was elevated significantly at 30 minutes after the reperfusion of the graft and at the end of operation （all P〈0. 05）. Both DO2 and VO2 were decreased significantly during the anhepatic phase （both P〈0. 05）, and increased significantly after graft reperfusion （all P〈0. 05） ; ERO2 increased significantly after graft reperfusion （P〈0.05）. The level of SvO2 was correlated with VOz significantly at each stage （all P〈0.05）, but not with DOz and hemoglobin （all P〈0. 05）. SvOz was correlated well with CO before operation （P〈0. 05）, but not at the other time points （all P〈0. 05）, Conclusion Monitoring SvO2 continually is of clinical significance in patients during OLT.